Healthcare Provider Details

I. General information

NPI: 1184850398
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490A W ZIA RD STE 200
SANTA FE NM
87505-7007
US

IV. Provider business mailing address

490A W ZIA RD STE 200
SANTA FE NM
87505-7007
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3101
  • Fax: 505-913-3102
Mailing address:
  • Phone: 505-913-3101
  • Fax: 505-913-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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