Healthcare Provider Details

I. General information

NPI: 1154477941
Provider Name (Legal Business Name): ST. VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

PO BOX C12000
SANTA FE NM
87504-7000
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5470
  • Fax: 505-913-6489
Mailing address:
  • Phone: 505-913-3155
  • Fax: 505-913-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number6296
License Number StateNM

VIII. Authorized Official

Name: JOSEPH ALEX VALDEZ
Title or Position: CEO
Credential:
Phone: 505-820-5202