Provider Demographics
NPI:1699166140
Name:SANDIA NATIONAL LABORATORIES
Entity type:Organization
Organization Name:SANDIA NATIONAL LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOMMERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-844-7261
Mailing Address - Street 1:1515 EUBANK BLVD SE BLDG. 831/832
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:
Mailing Address - Fax:
Practice Address - Street 1:1515 EUBANK BLVD SE BLDG. 831/832
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87185-1019
Practice Address - Country:US
Practice Address - Phone:505-844-4237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health