Healthcare Provider Details

I. General information

NPI: 1578587150
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/21/2010
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: 505-820-5202
  • Fax:
Mailing address:
  • Phone: 505-913-3155
  • Fax: 505-913-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number6296
License Number StateNM

VIII. Authorized Official

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