NPIMap

Organization Active NPI

University of New Mexico Medical Group, Inc.

  • Student Health Clinic/Center
  • Albuquerque, NM
National Provider Identifier
1518129683
Registry record updated Jun 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
License
R45196 Issued in NM
Legal business name
UNIVERSITY OF NEW MEXICO MEDICAL GROUP, INC.
Practice address
1138 Cardenas Dr SE
Albuquerque, NM 87108-4809
Phone
(505) 934-2967
Fax
(505) 272-2043
NPI assigned
Jun 30, 2008
Last updated
Jun 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Anthony Masciotra
Title
Ceo
Phone
(505) 272-8950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student Health Clinic/Center 261QS1000X R45196 NM Primary

Addresses

Primary practice location

1138 Cardenas Dr SE
Albuquerque, NM 87108-4809

Mailing address

University of New Mexico School Based Health Ctr
Unmsc09 1 University of New Mexico
Albuquerque, NM 87131-0001
Phone (505) 272-0457

Other identifiers 1

IdentifierTypeStateIssuer
3A11MedicaidNM

National Provider Directory

National Provider Directory
Tax ID family
University of New Mexico Dental Services17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1518129683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF NEW MEXICO SCHOOL BASED HEALTH CTR",
            "address_2": "UNMSC09 1 UNIVERSITY OF NEW MEXICO",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871310001",
            "telephone_number": "505-272-0457",
            "fax_number": "505-272-2043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 CARDENAS DR SE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871084809",
            "telephone_number": "505-934-2967",
            "fax_number": "505-272-2043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF NEW MEXICO MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "MASCIOTRA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-272-8950",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NM",
            "license": "R45196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3A11",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.