Basic Information
| Provider Information | |||||||||
| NPI: | 1861968521 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST VINCENT HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 ST. MICHAEL'S DRIVE, CSV MEDICAL GROUP | ||||||||
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| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059135227 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1631 HOSPITAL DR STE 100 | ||||||||
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| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875057631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059133626 | ||||||||
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| ProviderEnumerationDate: | 10/22/2018 | ||||||||
| LastUpdateDate: | 10/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | MONTOYA | ||||||||
| AuthorizedOfficialFirstName: | LILLIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5059135221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.