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General NPI Number Information
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NPI Number | 1679804009
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Entity Type | Organization
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Legal Business Name | B&W STAT LABORATORY, INC.
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 3104 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20010-2902
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Country | US
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Telephone | 202-726-0842
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Fax | 202-726-5214
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Provider Business Mailing Address
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Address Line | 3104 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20010-2902
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Country | US
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Telephone | 202-726-0842
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Fax | 202-726-5214
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. CLIFTON NORRIS WEST JR.
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Credential | MT
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Telephone | 202-726-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 09D0208053
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License Number State | DC
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