Healthcare Provider Details

I. General information

NPI: 1083992846
Provider Name (Legal Business Name): SANDIA NATIONAL LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK BLVD SE BLDG 831/832
ALBUQUERQUE NM
87123-3453
US

IV. Provider business mailing address

PO BOX 5800
ALBUQUERQUE NM
87185-1019
US

V. Phone/Fax

Practice location:
  • Phone: 505-844-4237
  • Fax: 505-845-8190
Mailing address:
  • Phone: 505-845-0145
  • Fax: 505-845-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICK SAUERMAN
Title or Position: SITE OCCUPATIONAL MEDICAL DIRECTOR
Credential: MD
Phone: 505-845-0145