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General NPI Number Information
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NPI Number | 1396716643
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Entity Type | Organization
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Legal Business Name | SAN MIGUEL HOSPITAL CORPORATION
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 104 LEGION DR
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City | LAS VEGAS
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State | NM
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Zip | 87701-4804
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Country | US
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Telephone | 505-426-3500
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Fax | 505-454-9502
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Provider Business Mailing Address
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Address Line | 104 LEGION DR
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City | LAS VEGAS
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State | NM
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Zip | 87701-4804
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Country | US
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Telephone | 505-426-3500
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Fax | 505-454-9502
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Authorized Official
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Title or Position | SVP FINANCE OP/AUTHORIZED OFFICIAL
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Name | RANDY MICHAEL COOPER
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Credential |
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Telephone | 615-221-3840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 3005
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License Number State | NM
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