Healthcare Provider Details

I. General information

NPI: 1417330044
Provider Name (Legal Business Name): UNM MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE STE B4
ALBUQUERQUE NM
87102-2642
US

IV. Provider business mailing address

801 ENCINO PL NE SUITE B4
ALBUQUERQUE NM
87102-2612
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-0996
  • Fax: 505-925-0995
Mailing address:
  • Phone: 505-925-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00003960
License Number StateNM

VIII. Authorized Official

Name: SAM SANCHEZ
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMACY
Phone: 505-925-0988