Healthcare Provider Details

I. General information

NPI: 1275724510
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 211
SANTA FE NM
87505-7670
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: 505-984-2600
  • Fax:
Mailing address:
  • Phone: 505-984-2600
  • Fax: 505-983-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: J ALEX VALDEZ
Title or Position: PRESIDENT AND CEO
Credential: JD
Phone: 505-820-5202