Healthcare Provider Details

I. General information

NPI: 1508403528
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SAINT MICHAELS DR STE 150
SANTA FE NM
87505-7637
US

IV. Provider business mailing address

440 SAINT MICHAELS DR STE 150
SANTA FE NM
87505-7637
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5363
  • Fax: 505-989-6409
Mailing address:
  • Phone: 505-913-5363
  • Fax: 505-989-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: HOPE WADE
Title or Position: COO
Credential:
Phone: 928-607-0495