Notifier: Professional Clinical Laboratories, LLC / 2434 ... · Laboratory Copy - WHITE Patient...
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Laboratory Copy - WHITE Patient Copy - YELLOW Form CMS-R-131 Exp. 03/2020 Form Approved OMB No. 0938-0566 Notifier: Professional Clinical Laboratories, LLC / 2434 Interstate Plaza Drive / Hammond, IN 46324 877-937-2190 $90.00 CMS does not discriminate in its programs and activities. To require this publication in an alternative format, please call: 1-800-MEDICARE or email: [email protected]
Transcript of Notifier: Professional Clinical Laboratories, LLC / 2434 ... · Laboratory Copy - WHITE Patient...
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Laboratory Copy - WHITE Patient Copy - YELLOWForm CMS-R-131 Exp. 03/2020 Form Approved OMB No. 0938-0566
Notifier: Professional Clinical Laboratories, LLC / 2434 Interstate Plaza Drive / Hammond, IN 46324877-937-2190
$90.00
CMS does not discriminate in its programs and activities. To require this publication in an alternative format, please call: 1-800-MEDICARE or email: [email protected]