Healthcare Provider Details

I. General information

NPI: 1568766210
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-2600
  • Fax: 505-983-7299
Mailing address:
  • Phone: 505-984-2600
  • Fax: 505-983-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number6296
License Number StateNM

VIII. Authorized Official

Name: JOSEPH ALEX VALDEZ
Title or Position: PRESIDENT / CEO
Credential:
Phone: 505-820-5202