Healthcare Provider Details

I. General information

NPI: 1366710956
Provider Name (Legal Business Name): UNM HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE NE
ALBUQUERQUE NM
87131
US

IV. Provider business mailing address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-4106
  • Fax: 505-272-4743
Mailing address:
  • Phone: 505-925-4106
  • Fax: 505-272-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberR60792
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberR60792
License Number StateNM

VIII. Authorized Official

Name: MRS. JANET MARIE POLLOCK
Title or Position: SENIOR CLINIC NURSE
Credential: RN,BC
Phone: 505-925-4106