Healthcare Provider Details

I. General information

NPI: 1740307347
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 HOSPITAL DR SUITE 240
SANTA FE NM
87505-4728
US

IV. Provider business mailing address

1631 HOSPITAL DR SUITE 240
SANTA FE NM
87505-4728
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-3975
  • Fax: 505-986-8001
Mailing address:
  • Phone: 505-988-3975
  • Fax: 505-954-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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