45D2141938 CLIA NUMBER - AIR EVAC LIFETEAM 148/MAC 1

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Laboratory Demographics

CLIA Number: 45D2141938

Facility Name: AIR EVAC LIFETEAM 148/MAC 1

Facility Address:
1115 PAUL WILKINS STREET
SAN ANTONIO, TX
ZIP 78216
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Facility Phone Number: 210 592-8646

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1285003889

Taxonomy: 3416A0800X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	45D2141938
LAB Type	Mobile Laboratory
Facility Name	AIR EVAC LIFETEAM 148/MAC 1
Street	1115 PAUL WILKINS STREET
City	SAN ANTONIO
State	TX
ZIP	78216
Phone	210 592-8646
CertificateType	4
CertificateEffectiveDate	12/28/2023
CertificateExpirationDate	12/27/2025
FacilityType	Waiver

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