# UNIVERSITY OF NEW MEXICO MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790946739
- **Authorized official:** MR. ANTHONY MASCIOTRA (CEO)
- **Authorized official phone:** (505) 272-8950

## Contact information

- **Practice address:** 11799 STATE HIGHWAY 14 S, TIJERAS, NM 87059-8619
- **Practice address phone:** (505) 281-3602
- **Practice address fax:** (505) 281-3602
- **Mailing address:** UNM SCHOOL BASED HEALTH CTRS, MSC09 5040, ALBUQUERQUE, NM 87131-0001
- **Mailing address phone:** (505) 272-0457
- **Mailing address fax:** (505) 272-2043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1000X | Student Health Clinic/Center | PA 2004-0048 | NM | Yes |

## Other

- **Enumeration date:** 06/23/2008
- **Last updated:** 06/23/2008