Healthcare Provider Details

I. General information

NPI: 1285829366
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 202
SANTA FE NM
87505
US

IV. Provider business mailing address

2055 S PACHECO ST STE 300
SANTA FE NM
87505-0504
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-0303
  • Fax: 505-984-1116
Mailing address:
  • Phone: 505-984-0303
  • Fax: 505-984-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LILLIAN MONTOYA
Title or Position: PRESIDENT & CEO
Credential:
Phone: 505-913-5202