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NPI Code Detail

MEDICARE: SAN MIGUEL HOSPITAL CORPORATION

MEDICARE: SAN MIGUEL HOSPITAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1275N00000XMedicare Defined Swing Bed Hospital Unit3005NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487625257
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN MIGUEL HOSPITAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 846331
Second Line :
City : DALLAS
State : TX
Zip : 75284-6331
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 104 LEGION DR
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4804
Country : US
Telephone Number : 505-426-3500
Fax Number : 505-454-9502
Authorized Official
Title or Position : SVP FINANCE OP/AUTHORIZED OFFICIAL
Name : RANDY MICHAEL COOPER
Credential :
Telephone Number : 615-221-3840
Provider Enumeration Date : 01/30/2006
Last Update Date : 08/11/2020

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Directions to “SAN MIGUEL HOSPITAL CORPORATION ” Practice Location

Language Start Address Practice Location
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