Healthcare Provider Details

I. General information

NPI: 1598940033
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 HOSPITAL DR
SANTA FE NM
87505
US

IV. Provider business mailing address

455 ST MICHAELS DR
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4848
  • Fax: 505-984-1149
Mailing address:
  • Phone: 505-913-5227
  • Fax: 505-913-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

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