Healthcare Provider Details

I. General information

NPI: 1255199352
Provider Name (Legal Business Name): UNITED WOUND & VASCULAR INSTITUTE NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SUN AVE NE STE 650
ALBUQUERQUE NM
87109-4670
US

IV. Provider business mailing address

PO BOX 7412472
CHICAGO IL
60674-2472
US

V. Phone/Fax

Practice location:
  • Phone: 888-402-0202
  • Fax: 888-860-2960
Mailing address:
  • Phone: 248-607-0037
  • Fax: 734-462-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MILLER
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 248-331-7908