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
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1184193450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN MIGUEL HOSPITAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 18428
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4079
Country	:	US
Telephone Number	:	505-425-2662
Fax Number	:	505-425-6410

Provider Business Practice Location Address
First Line	:	108 LEGION DR STE A
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4898
Country	:	US
Telephone Number	:	505-425-2662
Fax Number	:	505-425-6410

Authorized Official
Title or Position	:	SR. DIRECTOR PHYSICIAN REV CYCLE
Name	:	LAURA J FEY
Credential	:
Telephone Number	:	615-221-3641

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	07/07/2023

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