45D2068676 CLIA NUMBER - PHI AIR MEDICAL- CEDTX

Laboratory Demographics

  • CLIA Code: 45D2068676
  • Facility Name: PHI AIR MEDICAL- CEDTX
  • Facility Address: 525 B UNION CHAPEL RD
    CEDAR CREEK, TX
    ZIP 78612
  • Facility Phone: 601 507-9714
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: TRAE N. BANE
  • NPI Number: 1306289996
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 45D2068676
LAB Type Ambulance
Facility Name PHI AIR MEDICAL- CEDTX
Street 525 B UNION CHAPEL RD
City CEDAR CREEK
State TX
ZIP 78612
Phone 601 507-9714
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Ambulance
Lab Director TRAE N. BANE

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This page was last updated on: 9/29/2025