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General NPI Number Information
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NPI Number | 1912119298
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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 | 05/07/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 5 PETROGLYPH CIRCLE SUITE A
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City | POJOAQUE
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State | NM
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Zip | 87506
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Country | US
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Telephone | 505-983-3361
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Fax |
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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 | 505-820-5227
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. J ALEX VALDEZ
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Credential |
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Telephone | 505-983-3361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | MD2007-0167
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License Number State | NM
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