Provider Demographics
NPI:1649446089
Name:UNIVERSITY OF NEW MEXICO
Entity type:Organization
Organization Name:UNIVERSITY OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR GME
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-272-6225
Mailing Address - Street 1:328 ESCENA ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2886
Mailing Address - Country:US
Mailing Address - Phone:979-255-3090
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY SOM MSC09 5030
Practice Address - Street 2:UNIVERISTY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-5417
Practice Address - Fax:505-272-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit