=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811384019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PCL LAB LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2015
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11275 E MISSISSIPPI AVE STE 2W1
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80012-2828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-856-7177
-----------------------------------------------------
Fax | 303-856-3924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11275 E MISSISSIPPI AVE STE 2W1
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80012-2828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-856-7177
-----------------------------------------------------
Fax | 303-856-3924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOYCE MENGESHA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-856-7177
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------