Organization
CLINICAL REFERENCE LABORATORY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK COTTRELL (OWNER)
(956) 225-5896
Entity
Organization
Contact information
Practice address
216 W NOLANA, MCALLEN, TX 78504-2513
(956) 225-5896
Mailing address
216 W NOLANA, MCALLEN, TX 78504-2513
(956) 225-5896
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D201105
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2011051
CERTIFICATION NUMBER
TX
Enumeration date
08/19/2010
Last updated
08/23/2010
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