Provider Demographics
NPI:1447464664
Name:UNM HOSPITAL
Entity type:Organization
Organization Name:UNM HOSPITAL
Other - Org Name:<UNAVAIL>
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 1:2600 MARBLE AVE., N.E.
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2058
Practice Address - Country:US
Practice Address - Phone:505-272-2861
Practice Address - Fax:505-272-2016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNM HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM-10004-M261QM2800X
261QR0405X, 273R00000X
NM6005273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00092Medicaid
NM28350839Medicaid
NM00092Medicaid
NM28350839Medicaid