51D2180047 CLIA NUMBER - TERRA ALTA COMMUNITY AMBULANCE SQUAD, INC

Laboratory Demographics

  • CLIA Code: 51D2180047
  • Facility Name: TERRA ALTA COMMUNITY AMBULANCE SQUAD, INC
  • Facility Address: 1124 E STATE AVE
    TERRA ALTA, WV
    ZIP 26764
  • Facility Phone: (304) 789-6566
  • Facility Type: Ambulance
  • Facility Type: Waiver
  • Lab Director: DR. MARAM HAKOUM
  • NPI Number: 1619969722
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 51D2180047
LAB Type Ambulance
Facility Name TERRA ALTA COMMUNITY AMBULANCE SQUAD, INC
Street 1124 E STATE AVE
City TERRA ALTA
State WV
ZIP 26764
Phone 3047896566
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2026
Certificate Expiration Date 3/4/2028
Facility Type Ambulance
Lab Director DR. MARAM HAKOUM

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This page was last updated on: 5/18/2026