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
2718 SE LOOP 820, FT WORTH, TX 76140-1011
(866) 776-5221
(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
CLIA45D0942000
TX
291U00000X
Clinical Medical Laboratory
E0056
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025542401
—
TX
Enumeration date
11/09/2005
Last updated
12/03/2009
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