45D2003900 CLIA NUMBER - FAYETTE COUNTY EMS - STATION 1

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Laboratory Demographics

CLIA Number: 45D2003900

Facility Name: FAYETTE COUNTY EMS - STATION 1

Facility Address:
1721 N. VON MINDEN RD
LA GRANGE, TX
ZIP 78945
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Facility Phone Number: 979 968-8991

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1215958863

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	45D2003900
LAB Type	Ambulance
Facility Name	FAYETTE COUNTY EMS - STATION 1
Street	1721 N. VON MINDEN RD
City	LA GRANGE
State	TX
ZIP	78945
Phone	979 968-8991
CertificateType	4
CertificateEffectiveDate	2/22/2024
CertificateExpirationDate	2/21/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024