Provider Demographics
NPI:1518176692
Name:THE UNIVERSITY OF NEW MEXICO HEALTH SCIENCES CENTER
Entity Type:Organization
Organization Name:THE UNIVERSITY OF NEW MEXICO HEALTH SCIENCES CENTER
Other - Org Name:NEW MEXICO NEWBORN TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC. PROFESSOR NEWBORN TRANSPORT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-272-6409
Mailing Address - Street 1:MSC10 5590
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-2275
Mailing Address - Fax:
Practice Address - Street 1:MSC10 5590
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMF000253416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG2199Medicaid
NM642OtherCHAMPUS
NM69715OtherPRES
NMNM0021ROtherBCBS