Healthcare Provider Details

I. General information

NPI: 1821317355
Provider Name (Legal Business Name): UNM MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAMINO DE SALUD NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

MSC 07 4025 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4443
  • Fax:
Mailing address:
  • Phone: 505-272-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONALD WHITEHEAD
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 505-272-4443