Healthcare Provider Details

I. General information

NPI: 1144689514
Provider Name (Legal Business Name): ST VINCENT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR STE 112
SANTA FE NM
87505-7621
US

IV. Provider business mailing address

465 SAINT MICHAELS DR STE 112
SANTA FE NM
87505-7621
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5000
  • Fax: 505-913-3698
Mailing address:
  • Phone: 505-913-5000
  • Fax: 505-913-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00004173
License Number StateNM

VIII. Authorized Official

Name: RICK CANBY
Title or Position: MANAGER
Credential: RPH
Phone: 505-913-5000