Healthcare Provider Details

I. General information

NPI: 1215054788
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HOSPITAL DR SUITE 200
SANTA FE NM
87505-4728
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: 505-424-0200
  • Fax: 505-424-6608
Mailing address:
  • Phone: 505-424-0200
  • Fax: 505-424-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: J ALEX VALDEZ
Title or Position: CEO PRESIDENT
Credential:
Phone: 505-820-5227