Provider Demographics
NPI:1689778789
Name:UNMHSC DEPARTMENT OF PEDIATRICS
Entity Type:Organization
Organization Name:UNMHSC DEPARTMENT OF PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DILTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-272-4443
Mailing Address - Street 1:6465 TAYLOR MILL RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-9392
Mailing Address - Country:US
Mailing Address - Phone:859-363-4952
Mailing Address - Fax:859-363-4984
Practice Address - Street 1:2211 LOMAS NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3617
Practice Address - Fax:505-272-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty