1568444834 NPI number — UNIVERSITY OF NEW MEXICO PSYCHIATRIC CENTER

Table of content: (NPI 1568444834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568444834 NPI number — UNIVERSITY OF NEW MEXICO PSYCHIATRIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF NEW MEXICO PSYCHIATRIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNM MENTAL HEALTH CENTER
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568444834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 MARBLE AVENUE NORTHEAST
Provider Second Line Business Mailing Address:
CONTINUING CARE CLINIC
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87131-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-2826
Provider Business Mailing Address Fax Number:
505-272-8088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 MARBLE AVE. N.E.
Provider Second Line Business Practice Location Address:
CONTINUING CARE CLINIC
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87131-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-2826
Provider Business Practice Location Address Fax Number:
505-272-8088
Provider Enumeration Date:
11/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MONIE
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
REGISTERED NURSE
Authorized Official Telephone Number:
505-272-3041

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  R18768 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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