Healthcare Provider Details

I. General information

NPI: 1669597258
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR # 200
SANTA FE NM
87505
US

IV. Provider business mailing address

465 SAINT MICHAELS DR STE 200
SANTA FE NM
87505-7670
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-4901
  • Fax: 505-913-6426
Mailing address:
  • Phone: 505-913-4901
  • Fax: 505-913-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LILLIAM MONTOYA
Title or Position: CEO PRESIDENT
Credential:
Phone: 505-913-5201