Basic Information
| Provider Information | |||||||||
| NPI: | 1649446089 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF NEW MEXICO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 328 ESCENA ST SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871232886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9792553090 | ||||||||
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| Practice Location | |||||||||
| Address1: | DEPARTMENT OF PSYCHIATRY SOM MSC09 5030 | ||||||||
| Address2: | UNIVERISTY OF NEW MEXICO | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725417 | ||||||||
| FaxNumber: | 5052724639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2008 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | SPARKMAN | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR GME | ||||||||
| AuthorizedOfficialTelephone: | 5052726225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.