MEDICARE: ST. VINCENT HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144627332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. VINCENT HOSPITAL

Provider Business Mailing Address
First Line	:	455 ST MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 HERRERA DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2684
Country	:	US
Telephone Number	:	505-913-3233
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	LILLIAN MONTOYA
Credential	:
Telephone Number	:	505-913-5258

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	11/02/2018

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Directions to “ST. VINCENT HOSPITAL ” Practice Location

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