Organization
SAN MIGUEL CLINIC CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA J FEY (DIRECTOR REVENUE CYCLE)
(615) 221-3641
Entity
Organization
Contact information
Practice address
108 LEGION DR STE A, LAS VEGAS, NM 87701-4898
(505) 454-9499
Mailing address
PO BOX 5009, BRENTWOOD, TN 37024-5009
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47485817
—
NM
Enumeration date
05/27/2005
Last updated
10/17/2023
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