Healthcare Provider Details

I. General information

NPI: 1548387723
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 HARKLE RD SUITE D
SANTA FE NM
87505-4753
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: 505-988-3233
  • Fax: 505-988-3562
Mailing address:
  • Phone: 505-820-5227
  • Fax: 505-820-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

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