Organization
PROFESSIONAL CLINICAL LABORATORY, INC.
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
2329 PARKER RD, CARROLLTON, TX 75010-4713
(866) 776-5221
(817) 568-1960
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10007948
AMERIGROUP
TX
01
—
690008760
RAILROAD MEDICARE
TX
01
—
CL5046
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/11/2007
Last updated
12/03/2009
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