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General NPI Number Information
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NPI Number | 1598882797
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Entity Type | Organization
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Legal Business Name | ST. VINCENT HOSPITAL
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 530 HARKLE RD SUITE A
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City | SANTA FE
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State | NM
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Zip | 87505-4713
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Country | US
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Telephone | 505-983-6911
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Fax | 505-983-7212
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Provider Business Mailing Address
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Address Line | 455 SAINT MICHAELS DR MEDICAL STAFF OFFICE
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City | SANTA FE
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State | NM
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Zip | 87505-7601
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Country | US
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Telephone | 505-820-8227
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Fax | 505-820-5440
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CARLA L GOMEZ
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Credential |
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Telephone | 505-820-5227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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