| University Of New Mexico Medical Group, Inc. | |
|
700 Louisiana Se Albuquerque NM 87108 | |
| (505) 256-2555 | |
| (505) 256-2555 |
| Full Name | University Of New Mexico Medical Group, Inc. |
|---|---|
| Speciality | Clinic/center - Student Health |
| Location | 700 Louisiana Se, Albuquerque, New Mexico |
| Authorized Official Name and Position | Anthony Masciotra (CEO) |
| Authorized Official Contact | 5052728950 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| University Of New Mexico Medical Group, Inc. Unm School Based Health Ctrs Msc09 1 University Of New Mexico Albuquerque NM 87131-0001 Ph: (502) 720-4575 | University Of New Mexico Medical Group, Inc. 700 Louisiana Se Albuquerque NM 87108 Ph: (505) 256-2555 |
| NPI Number | 1043472111 |
|---|---|
| Provider Enumeration Date | 06/30/2008 |
| Last Update Date | 06/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043472111 | NPI | - | NPPES |
| 3A04 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | 88-PA05 (New Mexico) | Primary |
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