Healthcare Provider Details

I. General information

NPI: 1477190882
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR STE 230
SANTA FE NM
87505-7670
US

IV. Provider business mailing address

465 SAINT MICHAELS DR STE 230
SANTA FE NM
87505-7670
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-4780
  • Fax: 505-913-6780
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOPE WADE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 505-913-5203