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Organization

PROFESSIONAL CLINICAL LABORATORY INC

Active
Other names
ProLab
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. HOLLY R SHIELDS B.S., MT,ASCP (VICE PRESIDENT-COO)
(866) 776-5221
Entity
Organization

Contact information

Practice address
234 AQUARIUS DR, SUITE 122, BIRMINGHAM, AL 35209-5872
(866) 776-2221
(817) 568-1960
Mailing address
3020 WICHITA CT, FT WORTH, TX 76140-1710
(866) 776-5221
(817) 568-1960

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
025542401
TX
05
06408362
MS
05
1523402
LA
05
160698001
TX
05
164542709
AR
05
200094750A
OK
05
690000082
AL
01
690008760
RAILROAD MEDICARE
01
CL5046
BLUE CROSS BLUE SHIELD
TX
01
P00377679
RAILROAD MEDICARE
01
P00377680
RAILROAD MEDICARE
Enumeration date
04/26/2010
Last updated
04/26/2010
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