Professional Clinical Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLIA45D0942000 Issued in TX

Legal business name

PROFESSIONAL CLINICAL LABORATORY INC

Practice address

2718 SE Loop 820
Ft Worth, TX 76140-1011

Phone

(866) 776-5221

Fax

(817) 568-1960

NPI assigned

Nov 9, 2005

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 2

Addresses

Other identifiers 1

Other names 1

• ProLab Doing business as

Locations

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259798400000",
    "number": "1992786743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 WICHITA CT",
            "city": "FT 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": "2718 SE LOOP 820",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761401011",
            "telephone_number": "866-776-5221",
            "fax_number": "817-568-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CLINICAL LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-09",
        "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": "TX",
            "license": "E0056",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TX",
            "license": "CLIA45D0942000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025542401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProLab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pro Physicians Clinic PA
• Procare Home Care & Sitter Service Co Inc
• Procare Pharmacy LLC
• Procare Pharmacy, LLC
• Professional Caretakers Inc.
• Professional Clinical Laboratory, Inc
• Professional Counseling Center PLLC
• Professional Ehc Eastchase LLC
• Progressive Home Care Fort Worth Inc.
• Progressive Pathways Psychiatry PLLC

• Clinical Medical Laboratory in Ft Worth, TX
• Providers in Ft Worth, TX by specialty
• Clinical Medical Laboratory in Texas

• 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.