Healthcare Provider Details

I. General information

NPI: 1447464664
Provider Name (Legal Business Name): UNM HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE., N.E.
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

400 TIJERAS AVE NW STE 450
ALBUQUERQUE NM
87102-3273
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2861
  • Fax: 505-272-2016
Mailing address:
  • Phone: 505-272-4275
  • Fax: 505-272-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License NumberNM-10004-M
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number6005
License Number StateNM

VIII. Authorized Official

Name: BONNIE MARIE WHITE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 505-272-1840