Healthcare Provider Details

I. General information

NPI: 1770982951
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490B W ZIA RD SUITE 4
SANTA FE NM
87505-7008
US

IV. Provider business mailing address

490B W ZIA RD SUITE 4
SANTA FE NM
87505-7008
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3820
  • Fax: 505-913-3829
Mailing address:
  • Phone: 505-913-3820
  • Fax: 505-913-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateNM

VIII. Authorized Official

Name: BRUCE TASSIN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 505-913-5202