St Jude Medical Center Corp

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ST JUDE MEDICAL CENTER CORP

Practice address

400 Gold Ave SW Ste 220
Albuquerque, NM 87102-3278

Phone

(682) 309-8936

NPI assigned

Aug 10, 2019

Organization subpart

No

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

Authorized official

Name

Uyama A Fernandez

Title

President

Phone

(682) 309-8936

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1565395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1760038350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 GOLD AVE SW STE 220",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871023278",
            "telephone_number": "682-309-8936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GOLD AVE SW STE 220",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871023278",
            "telephone_number": "682-309-8936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE MEDICAL CENTER CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-10",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "UYAMA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "682-309-8936"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• General Practice Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; 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.