Provider Demographics
NPI:1902350697
Name:UNM HOSPITAL
Entity Type:Organization
Organization Name:UNM HOSPITAL
Other - Org Name:UNMH HOME CARE
Other - Org Type:Doing Business As
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:505-272-2521
Mailing Address - Fax:505-272-4424
Practice Address - Street 1:2600 YALE BLVD SE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4383
Practice Address - Country:US
Practice Address - Phone:505-272-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNM HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-10
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3554251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39838315Medicaid