Provider Demographics
NPI:1932206117
Name:MEDICINE AT DOWNTOWN LTD.
Entity Type:Organization
Organization Name:MEDICINE AT DOWNTOWN LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:UNVERZAGT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-246-1670
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87103-0313
Mailing Address - Country:US
Mailing Address - Phone:505-246-1670
Mailing Address - Fax:505-246-1677
Practice Address - Street 1:925 COAL AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3743
Practice Address - Country:US
Practice Address - Phone:505-246-1670
Practice Address - Fax:505-246-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-061797-00-9261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM800521182Medicare PIN