Provider Demographics
NPI:1770841728
Name:UNM HOSPITAL
Entity Type:Organization
Organization Name:UNM HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:MIKULEC
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:505-272-2325
Mailing Address - Street 1:2211 LOMAS BLVD., 3RD FLOOR
Mailing Address - Street 2:UNM HOSPITAL-PEDIATRIC NEUROLOGY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131
Mailing Address - Country:US
Mailing Address - Phone:505-272-2325
Mailing Address - Fax:505-277-1363
Practice Address - Street 1:UNM HOSPITAL PEDIATRIC NEUROLOGY
Practice Address - Street 2:2211 LOMAS BLVD., 3RD FLOOR
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2325
Practice Address - Fax:505-277-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2011-0042282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital