Provider Demographics
NPI:1629230966
Name:UNIVERSITY OF NEW MEXICO HOSPITAL-BERNALILLO COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF NEW MEXICO HOSPITAL-BERNALILLO COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-272-1840
Mailing Address - Street 1:1209 UNIVERSITY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1727
Mailing Address - Country:US
Mailing Address - Phone:505-272-4574
Mailing Address - Fax:505-272-8882
Practice Address - Street 1:1209 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1727
Practice Address - Country:US
Practice Address - Phone:505-272-4574
Practice Address - Fax:505-272-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6005332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00067Medicaid
NM00067Medicaid
NM0800210003Medicare NSC