CLIA lab
CLIA 36D0862504: Jackson-Forest Ambulance District
Forest, OH. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 36D0862504 belongs to Jackson-Forest Ambulance District in Forest, OH.
Certificate of Waiver, effective September 1, 2026, expires August 31, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Run it in Rivvi
Map your lab's test names to LOINC codes
Open in RivviFree to start. Opens Rivvi, the AI workspace for healthcare teams.
Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- September 1, 2026
- Certificate expiration
- August 31, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- February 24, 1993
- Facility type
- Other
- Ownership (control type)
- Government, other
- Lab classification
- CLIA laboratory
- Directly affiliated labs
- 1
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 36D0862504
- Lab name
- Jackson-Forest Ambulance District
- Address
- 211 West Lima Street, Forest, OH 45843
- Phone
- (419) 273-2520
Annual test volume the lab reported
- Waived tests
- 6
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Forest, OH
Related
Questions
What is the CLIA number for Jackson-Forest Ambulance District in Forest?
36D0862504, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Jackson-Forest Ambulance District hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 36D0862504 expire?
The CMS file lists August 31, 2028 as the certificate expiration date; the certificate took effect September 1, 2026.