MEDICARE: MEDICINE AT DOWNTOWN LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	03-061797-00-9	NM

General Provider Information

NPI Number	:	1932206117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE AT DOWNTOWN LTD.

Provider Business Mailing Address
First Line	:	PO BOX 313
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87103-0313
Country	:	US
Telephone Number	:	505-246-1670
Fax Number	:	505-246-1677

Provider Business Practice Location Address
First Line	:	925 COAL AVE SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3743
Country	:	US
Telephone Number	:	505-246-1670
Fax Number	:	505-246-1677

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK UNVERZAGT
Credential	:	M.D.
Telephone Number	:	505-246-1670

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/29/2008

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