Provider Demographics
NPI:1134165681
Name:UNM HOSPITAL
Entity type:Organization
Organization Name:UNM HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRIEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:505-272-0526
Mailing Address - Street 1:1209 UNIVERSITY BOULALARDVD 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:505-272-8674
Mailing Address - Fax:505-272-8882
Practice Address - Street 1:1209 UNIVERSITY BOULVARD 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:505-272-8674
Practice Address - Fax:505-272-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
NMPH000018373336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056394OtherPK
NM000055137Medicaid
NM0800210003Medicare NSC