Provider Demographics
NPI:1417330044
Name:UNM MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:UNM MEDICAL GROUP, INC.
Other - Org Name:UNM TRUMAN HEALTH SERVICES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:505-925-0988
Mailing Address - Street 1:801 ENCINO PL NE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2612
Mailing Address - Country:US
Mailing Address - Phone:505-925-0996
Mailing Address - Fax:
Practice Address - Street 1:801 ENCINO PL NE STE B4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2642
Practice Address - Country:US
Practice Address - Phone:505-925-0996
Practice Address - Fax:505-925-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NMPH000039603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152845OtherPK