Provider Demographics
NPI:1679804009
Name:B&W STAT LABORATORY, INC.
Entity Type:Organization
Organization Name:B&W STAT LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:NORRIS
Authorized Official - Last Name:WEST
Authorized Official - Suffix:JR
Authorized Official - Credentials:MT
Authorized Official - Phone:202-726-0842
Mailing Address - Street 1:3104 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2902
Mailing Address - Country:US
Mailing Address - Phone:202-726-0842
Mailing Address - Fax:202-726-5214
Practice Address - Street 1:3104 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2902
Practice Address - Country:US
Practice Address - Phone:202-726-0842
Practice Address - Fax:202-726-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC09D0208053291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory