Organization
PROFESSIONAL CLINICAL LABORATORY, INC
Active
Other names
ProLab
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HOLLY RENEA SHIELDS (COO/VICE PRESIDENT)
(866) 776-5221
Entity
Organization
Contact information
Practice address
3020 WICHITA CT, FT WORTH, TX 76140-1710
(866) 776-5221
(682) 647-6238
Mailing address
6660 DOUBLETREE AVE, COLUMBUS, OH 43229-1128
(866) 776-5221
(682) 647-6238
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
36D2050322
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00054521
—
MS
05
—
140312
—
AL
05
—
1523402
—
LA
05
—
160698001
—
TX
05
—
164542709
—
AR
05
—
191954001
—
TX
05
—
200094750A
—
OK
05
—
286063701
—
TX
01
—
690008760
RAILROAD MEDICARE
—
01
—
CL5046
BLUE CROSS BLUESHIELD
TX
Enumeration date
03/04/2013
Last updated
03/04/2013
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