Healthcare Provider Details

I. General information

NPI: 1861968521
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HOSPITAL DR STE 100
SANTA FE NM
87505-7631
US

IV. Provider business mailing address

455 ST. MICHAEL'S DRIVE, CSV MEDICAL GROUP
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3626
  • Fax:
Mailing address:
  • Phone: 505-913-5227
  • Fax:

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: LILLIAN MONTOYA
Title or Position: CEO
Credential:
Phone: 505-913-5221