Provider Demographics
NPI:1477173219
Name:UNIVERSITY OF NEW MEXICO HOSPITALS
Entity type:Organization
Organization Name:UNIVERSITY OF NEW MEXICO HOSPITALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO AMBULATORY
Authorized Official - Prefix:DR
Authorized Official - First Name:SIREESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPPULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MBA,MPH
Authorized Official - Phone:520-237-2545
Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2719
Mailing Address - Country:US
Mailing Address - Phone:520-237-2545
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:520-237-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty