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General NPI Number Information
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NPI Number | 1700130515
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Entity Type | Organization
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Legal Business Name | SANFORD WEST
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 300 N 7TH ST
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City | BISMARCK
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State | ND
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Zip | 58501-4439
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Country | US
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Telephone | 701-323-6000
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Fax | 701-323-5221
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Provider Business Mailing Address
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Address Line | 300 N 7TH ST
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City | BISMARCK
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State | ND
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Zip | 58501-4439
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Country | US
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Telephone | 701-323-6000
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Fax | 701-323-5221
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Authorized Official
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Title or Position | CEO AND PRESIDENT
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Name | CRAIG J LAMBRECHT
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Credential | MD
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Telephone | 701-323-6104
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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 | 35D0888428
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License Number State | ND
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