Provider Demographics
| NPI: | 1689747552 |
|---|---|
| Name: | UNM HOSPITAL |
| Entity type: | Organization |
| Organization Name: | UNM HOSPITAL |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BONNIE |
| Authorized Official - Middle Name: | MARIE |
| Authorized Official - Last Name: | WHITE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 505-272-1840 |
| Mailing Address - Street 1: | 400 TIJERAS AVE NW STE 450 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | ALBUQUERQUE |
| Mailing Address - State: | NM |
| Mailing Address - Zip Code: | 87102-3273 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 505-272-4275 |
| Mailing Address - Fax: | 505-272-9991 |
| Practice Address - Street 1: | 2211 LOMAS BLVD., N.E. |
| Practice Address - Street 2: | |
| Practice Address - City: | ALBUQUERQUE |
| Practice Address - State: | NM |
| Practice Address - Zip Code: | 87106-2719 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 505-272-1221 |
| Practice Address - Fax: | 505-272-1827 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-11-16 |
| Last Update Date: | 2024-07-10 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103TC0700X, 261QR0405X, 363A00000X, 363LA2100X, 364SA2100X, 364SP0808X | ||
| NM | 6005 | 225000000X, 251J00000X, 251K00000X, 273R00000X, 282N00000X, 332B00000X, 335E00000X, 3416A0800X |
| NM | NM-10004-M | 261QM2800X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | ||
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 225000000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter | Group - Multi-Specialty | |
| No | 251J00000X | Agencies | Nursing Care | Group - Multi-Specialty | |
| No | 251K00000X | Agencies | Public Health or Welfare | ||
| No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone | |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
| No | 273R00000X | Hospital Units | Psychiatric Unit | ||
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | ||
| No | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier | Group - Multi-Specialty | |
| No | 3416A0800X | Transportation Services | Ambulance | Air Transport | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
| No | 364SA2100X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Acute Care | Group - Multi-Specialty |
| No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NM | 60054 | Other | AETNA |
| NM | 62308 | Other | CIGNA |
| NM | 201080119 | Other | PRESBYTERIAN SALUD |
| NM | 24409065 | Medicaid | |
| NM | 0003 | Other | CHAMPUS |
| NM | 450 | Other | LOVELACE SALUD |
| NM | 00000092 | Medicaid | |
| NM | T2313 | Medicaid | |
| NM | 02156901 | Other | AHCCCS |
| NM | 03709779 | Medicaid | |
| NM | 00000067 | Medicaid | |
| NM | 28350839 | Medicaid | |
| NM | NM00006 | Other | BCBS |
| NM | T2313 | Medicaid | |
| NM | 00000067 | Medicaid | |
| 320001 | Medicare Oscar/Certification | ||
| NM | 02156901 | Other | AHCCCS |
