Provider Demographics
NPI:1184193450
Name:SAN MIGUEL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:SAN MIGUEL HOSPITAL CORPORATION
Other - Org Name:LAS VEGAS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR PHYSICIAN REV CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:PO BOX 18428
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4079
Mailing Address - Country:US
Mailing Address - Phone:505-425-2662
Mailing Address - Fax:505-425-6410
Practice Address - Street 1:108 LEGION DR STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4898
Practice Address - Country:US
Practice Address - Phone:505-425-2662
Practice Address - Fax:505-425-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health