| Name: | Professional Clinical Laboratory, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Corporation |
| Status: | Exists |
| Date of registration: | 19 Feb 1999 (26 years ago) (Companies founded in February 1999) |
| Entity Number: | 000-930-661 |
| Register Number: | 000930661 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Texas |
| Principal Address: | 2718-20 SE LOOP 820FORT WORTH, TX 76140-1011 |
| Registered Office Street Address: | 2 NORTH JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1285951665 | 2010-04-26 | 2010-04-26 | 3020 WICHITA CT, FT WORTH, TX, 761401710, US | 234 AQUARIUS DR, SUITE 122, BIRMINGHAM, AL, 352095872, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 866-776-5221 |
| Fax | 8175681960 |
| Phone | +1 866-776-2221 |
Authorized person
| Name | MRS. HOLLY R SHIELDS |
| Role | VICE PRESIDENT-COO |
| Phone | 8667765221 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1523402 |
| State | LA |
| Issuer | RAILROAD MEDICARE |
| Number | 690008760 |
| Issuer | RAILROAD MEDICARE |
| Number | P00377680 |
| Issuer | RAILROAD MEDICARE |
| Number | P00377679 |
| Issuer | MEDICAID |
| Number | 025542401 |
| State | TX |
| Issuer | MEDICAID |
| Number | 164542709 |
| State | AR |
| Issuer | MEDICAID |
| Number | 690000082 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | CL5046 |
| State | TX |
| Issuer | MEDICAID |
| Number | 200094750A |
| State | OK |
| Issuer | MEDICAID |
| Number | 06408362 |
| State | MS |
| Issuer | MEDICAID |
| Number | 160698001 |
| State | TX |
| Name | Role |
|---|---|
| NATIONAL REGISTERED AGENTS INC | Agent |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
