Basic Information
| Provider Information | |||||||||
| NPI: | 1568933950 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNM MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 MENAUL BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871071851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 MENAUL BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871071851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | BAUGHMAN | ||||||||
| AuthorizedOfficialFirstName: | RENEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DELEGATED OFFICIAL/ SURROGATE | ||||||||
| AuthorizedOfficialTelephone: | 5052721476 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNM MEDICAL GROUP, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253Z00000X | Y | Agencies | In Home Supportive Care |
No ID Information.