Professional Clinical Laboratory, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PROFESSIONAL CLINICAL LABORATORY, INC.

Practice address

109 Fairmont PLZ
Pearl, MS 39208-3424

Phone

(866) 776-5221

Fax

(817) 568-1960

NPI assigned

May 8, 2006

Organization subpart

No

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

Authorized official

Name

Holly R Shields

Title

Coo

Phone

(866) 776-5221

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• PROLAB Doing business as

Locations

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259798400000",
    "number": "1376592279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 WICHITA CT",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761401710",
            "telephone_number": "866-776-5221",
            "fax_number": "817-568-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 FAIRMONT PLZ",
            "city": "PEARL",
            "state": "MS",
            "postal_code": "392083424",
            "telephone_number": "866-776-5221",
            "fax_number": "817-568-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CLINICAL LABORATORY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2009-12-03",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "866-776-5221"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4490761",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1523402",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "690000082",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06408362",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROLAB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Barry Wade Phillips
• Missy Giachelli Phillips
• Sydney Erin Phillips
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• Michael Powell, PT
• Providence Wellness, LLC
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• Quality Care Rehab, LLC
• R & K Transportation Services LLC
• R Mark Owens DMD PA

• Clinical Medical Laboratory in Pearl, MS
• Providers in Pearl, MS by specialty
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.