Provider Demographics
NPI:1083992846
Name:SANDIA NATIONAL LABORATORIES
Entity type:Organization
Organization Name:SANDIA NATIONAL LABORATORIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SITE OCCUPATIONAL MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-845-0145
Mailing Address - Street 1:PO BOX 5800
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87185-1019
Mailing Address - Country:US
Mailing Address - Phone:505-845-0145
Mailing Address - Fax:505-845-8190
Practice Address - Street 1:1515 EUBANK BLVD SE
Practice Address - Street 2:BLDG 831/832
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3453
Practice Address - Country:US
Practice Address - Phone:505-844-4237
Practice Address - Fax:505-845-8190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDIA NATIONAL LABORATORIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-28
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine