45D2149454 CLIA NUMBER - AIR EVAC LIFETEAM DBA SOUTHEAST TEXAS AIR RESCUE

Laboratory Demographics

  • CLIA Code: 45D2149454
  • Facility Name: AIR EVAC LIFETEAM DBA SOUTHEAST TEXAS AIR RESCUE
  • Facility Address: 19 THOMAS STREET
    JASPER, TX
    ZIP 75951
  • Facility Phone: 409 460-8148
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: ALYSON NICKUM-SMITH
  • NPI Number: 1801385661
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 45D2149454
LAB Type Ambulance
Facility Name AIR EVAC LIFETEAM DBA SOUTHEAST TEXAS AIR RESCUE
Street 19 THOMAS STREET
City JASPER
State TX
ZIP 75951
Phone 409 460-8148
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2024
Certificate Expiration Date 6/4/2026
Facility Type Ambulance
Lab Director ALYSON NICKUM-SMITH

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