Organization
SAN MIGUEL HOSPITAL CORPORATION
Active
Organization
SAN MIGUEL HOSPITAL CORPORATION
Active
Parent organization
SAN MIGUEL HOSPITAL CORPORATION
Other names
Alta Vista Regional Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
SAN MIGUEL HOSPITAL CORPORATION
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
PO BOX 846331, DALLAS, TX 75284-6331
Taxonomy
Speciality
Code
Description
License number
State
275N00000X
Medicare Defined Swing Bed Hospital Unit
Primary
3005
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M2389
—
NM
Enumeration date
01/30/2006
Last updated
08/11/2020
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