Healthcare Provider Details

I. General information

NPI: 1164801627
Provider Name (Legal Business Name): CHRISTUS ST VINCENT REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
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

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-4307
  • Fax:
Mailing address:
  • Phone: 505-913-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberRN76458
License Number StateNM

VIII. Authorized Official

Name: SANDRA JUDY
Title or Position: DIABETES CLINICAL EDUCATOR
Credential: BSN,RN,CDE
Phone: 505-913-4307