Healthcare Provider Details

I. General information

NPI: 1285372573
Provider Name (Legal Business Name): ST. VINCENT GENERAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 US HIGHWAY 24
LEADVILLE CO
80461-3978
US

IV. Provider business mailing address

816 W 4TH ST
LEADVILLE CO
80461-3861
US

V. Phone/Fax

Practice location:
  • Phone: 719-486-0230
  • Fax: 719-486-1077
Mailing address:
  • Phone: 719-486-0230
  • Fax: 719-486-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW DREESEN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 719-486-7161