Organization
PROFESSIONAL CLINICAL LABORATORY
Active
Other names
PROLAB
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY R SHIELDS (COO)
(866) 776-5221
Entity
Organization
Contact information
Practice address
7801 N ROBINSON AVE, SUITE J11, OKLAHOMA CITY, OK 73116-7726
(866) 776-5221
(817) 560-1960
Mailing address
3020 WICHITA CT, FORT WORTH, TX 76140-1710
(866) 776-5221
(817) 568-1960
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
37D1054866
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200094750A
—
OK
Enumeration date
06/20/2006
Last updated
12/03/2009
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