Basic Information
| Provider Information | |||||||||
| NPI: | 1689747552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNM HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 TIJERAS AVE NW STE 450 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871023273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052724275 | ||||||||
| FaxNumber: | 5052729991 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 LOMAS BLVD., N.E. | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871062719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052721221 | ||||||||
| FaxNumber: | 5052721827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | BONNIE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5052721840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 225000000X | 6005 | NM | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | 251J00000X | 6005 | NM | N | Agencies | Nursing Care | 335E00000X | 6005 | NM | N | Suppliers | Prosthetic/Orthotic Supplier | 3416A0800X | 6005 | NM | N | Transportation Services | Ambulance | Air Transport | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 251K00000X | 6005 | NM | N | Agencies | Public Health or Welfare | 261QM2800X | NM-10004-M | NM | N | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic | 273R00000X | 6005 | NM | N | Hospital Units | Psychiatric Unit | 273R00000X | NM | N | Hospital Units | Psychiatric Unit | 332B00000X | 6005 | NM | N | Suppliers | Durable Medical Equipment & Medical Supplies | 363LA2100X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 364SA2100X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care | 364SP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health | 282N00000X | 6005 | NM | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00000067 | 05 | NM | MEDICAID | 0003 | 01 | NM | CHAMPUS | OTHER | 24409065 | 05 | NM | MEDICAID | T2313 | 05 | NM | MEDICAID | 28350839 | 05 | NM | MEDICAID | 02156901 | 01 | NM | AHCCCS | OTHER | 00000092 | 05 | NM | MEDICAID | NM00006 | 01 | NM | BCBS | OTHER | 60054 | 01 | NM | AETNA | OTHER | 62308 | 01 | NM | CIGNA | OTHER | 201080119 | 01 | NM | PRESBYTERIAN SALUD | OTHER | 450 | 01 | NM | LOVELACE SALUD | OTHER | 03709779 | 05 | NM | MEDICAID |