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NPI Code Detail

MEDICARE: PROFESSIONAL CLINICAL LABORATORY INC

MEDICARE: PROFESSIONAL CLINICAL LABORATORY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical LaboratoryCLIA45D1042882TX

General Provider Information

NPI Number : 1770553182
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL CLINICAL LABORATORY INC
Provider Business Mailing Address
First Line : 3020 WICHITA CT
Second Line :
City : FT WORTH
State : TX
Zip : 76140-1710
Country : US
Telephone Number : 866-776-5221
Fax Number : 682-647-6239
Provider Business Practice Location Address
First Line : 5314 DASHWOOD DR
Second Line : THIRD FLOOR
City : HOUSTON
State : TX
Zip : 77081-4603
Country : US
Telephone Number : 866-776-5221
Fax Number : 682-647-6239
Authorized Official
Title or Position : COO
Name : HOLLY R SHIELDS
Credential :
Telephone Number : 866-776-5221
Provider Enumeration Date : 01/26/2006
Last Update Date : 07/17/2013

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Directions to “PROFESSIONAL CLINICAL LABORATORY INC ” Practice Location

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