=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669536603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNM HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 01/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1127 UNIVERSITY BLVD NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87102-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-272-5200
-----------------------------------------------------
Fax | 505-272-3215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 TIJERAS AVE NW STE 450
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87102-3273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-272-2521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | BONNIE MARIE WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-272-1840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 284300000X
-----------------------------------------------------
Taxonomy Name | Special Hospital
-----------------------------------------------------
License Number | 6074
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------