Professional Clinical Laboratory, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

52D1062818 Issued in WI

Legal business name

PROFESSIONAL CLINICAL LABORATORY, LLC

Practice address

1111 Delafield St
Suite 309
Waukesha, WI 53188-3417

Phone

(262) 542-8020

Fax

(262) 542-4312

NPI assigned

Feb 12, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. John E Stager, MS

Title

Manager

Phone

(262) 542-8020

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1174762264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST",
            "address_2": "SUITE 301",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883417",
            "telephone_number": "262-542-8020",
            "fax_number": "262-650-4398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 DELAFIELD ST",
            "address_2": "SUITE 309",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531883417",
            "telephone_number": "262-542-8020",
            "fax_number": "262-542-4312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CLINICAL LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-12",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "STAGER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "262-542-8020",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WI",
            "license": "52D1062818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Clinical Medical Laboratory in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.