Provider Demographics
NPI:1760517528
Name:UNM HEALTH SCIENCES CENTER P
Entity Type:Organization
Organization Name:UNM HEALTH SCIENCES CENTER P
Other - Org Name:CHILDREN PSYCHIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-272-2644
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87103-0369
Mailing Address - Country:US
Mailing Address - Phone:505-272-2521
Mailing Address - Fax:
Practice Address - Street 1:1001 YALE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3825
Practice Address - Country:US
Practice Address - Phone:505-272-2210
Practice Address - Fax:505-272-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6005283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0003OtherCHAMPUS
NM02156901OtherAHCCCS
NM450OtherLOVELACE SALUD
NM60054OtherAETNA
NM62308OtherCIGNA
NM29966OtherPRESBYTERIAN HEALTH PLAN
NM00092Medicaid
NMNM000006OtherBCBS
NM32S001Medicare ID - Type UnspecifiedMEDICARE SUB-PROVIDER NO.