Organization
SAN MIGUEL HOSPITAL CORPORATION
Active
Other names
Alta Vista Regional Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY MICHAEL COOPER (SVP FINANCE OP/AUTHORIZED OFFICIAL)
(615) 221-3840
Entity
Organization
Contact information
Practice address
104 LEGION DR, LAS VEGAS, NM 87701-4804
(505) 426-3500
(505) 454-9502
Mailing address
104 LEGION DR, LAS VEGAS, NM 87701-4804
(505) 426-3500
(505) 454-9502
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
3005
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24622
PHP SALUD
—
01
—
24644
PHP
—
05
—
76546
—
NM
01
—
NM000068
BCBS
NM
Enumeration date
01/26/2006
Last updated
08/11/2020
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