Healthcare Provider Details

I. General information

NPI: 1609218452
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 204
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: 505-913-3101
  • Fax:
Mailing address:
  • Phone: 505-913-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateNM

VIII. Authorized Official

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