Healthcare Provider Details

I. General information

NPI: 1891750436
Provider Name (Legal Business Name): ST. VINCENT GENERAL HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 W 4TH ST
LEADVILLE CO
80461-3861
US

IV. Provider business mailing address

822 W 4TH ST
LEADVILLE CO
80461-3861
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number0185
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number010908
License Number StateCO

VIII. Authorized Official

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