Provider Demographics
NPI:1881742161
Name:UNIVERSITY PSYCHIATRIC HOSPITAL-IP
Entity type:Organization
Organization Name:UNIVERSITY PSYCHIATRIC HOSPITAL-IP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
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 1:2600 MARBLE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2058
Practice Address - Country:US
Practice Address - Phone:505-272-2861
Practice Address - Fax:505-272-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6005273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0003OtherCHAMPUS
NM450OtherLOVELACE SALUD
NM2156901OtherAHCCCS
NM000092Medicaid
NMNM600644OtherVALUE BEHAVIORAL HEALTH
NM62308OtherCIGNA
NMNM000006OtherBCBS
NMNM000006OtherBCBS