| University Of New Mexico Medical Group, Inc. | |
|
11799 State Highway 14 S Tijeras NM 87059-8619 | |
| (505) 281-3602 | |
| (505) 281-3602 |
| Full Name | University Of New Mexico Medical Group, Inc. |
|---|---|
| Speciality | Clinic/center - Student Health |
| Location | 11799 State Highway 14 S, Tijeras, New Mexico |
| Authorized Official Name and Position | Anthony Masciotra (CEO) |
| Authorized Official Contact | 5052728950 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| University Of New Mexico Medical Group, Inc. Unm School Based Health Ctrs Msc09 5040 Albuquerque NM 87131-0001 Ph: (505) 272-0457 | University Of New Mexico Medical Group, Inc. 11799 State Highway 14 S Tijeras NM 87059-8619 Ph: (505) 281-3602 |
| NPI Number | 1790946739 |
|---|---|
| Provider Enumeration Date | 06/23/2008 |
| Last Update Date | 06/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790946739 | NPI | - | NPPES |
| 3A07 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | PA 2004-0048 (New Mexico) | Primary |