Basic Information
| Provider Information | |||||||||
| NPI: | 1639479520 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY OF NEW MEXICO HOSPITALS ASAP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASAP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 ALAMO AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871063204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059252400 | ||||||||
| FaxNumber: | 5059252411 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 ALAMO AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871063204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059252400 | ||||||||
| FaxNumber: | 5059252411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2010 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCKERNAN | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5052722070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNIVERSITY OF NEW MEXICO HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | L17349 | NM | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.