Healthcare Provider Details

I. General information

NPI: 1598882797
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 HARKLE RD SUITE A
SANTA FE NM
87505-4713
US

IV. Provider business mailing address

455 SAINT MICHAELS DR MEDICAL STAFF OFFICE
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-6911
  • Fax: 505-983-7212
Mailing address:
  • Phone: 505-820-8227
  • Fax: 505-820-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLA L GOMEZ
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 505-820-5227