Basic Information
| Provider Information | |||||||||
| NPI: | 1689778789 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNMHSC DEPARTMENT OF PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6465 TAYLOR MILL RD | ||||||||
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| City: | INDEPENDENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410519392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593634952 | ||||||||
| FaxNumber: | 8593634984 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 LOMAS NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723617 | ||||||||
| FaxNumber: | 5052728699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DILTS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | RUSSELL | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5052724443 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | NM | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.