=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851347942
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANESCO INTERNATIONAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 02/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 TRIDENT DR
-----------------------------------------------------
City | ARDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28704-7744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-670-5705
-----------------------------------------------------
Fax | 828-670-5805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 TRIDENT DR
-----------------------------------------------------
City | ARDEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28704-7744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-670-5705
-----------------------------------------------------
Fax | 828-670-5805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. CHRISTOPHER PATRICK KRAGEL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 828-252-1045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 34D1054007
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------