Provider Demographics
NPI: | 1083351969 |
---|---|
Name: | ST. VINCENT GENERAL HOSPITAL DISTRICT |
Entity Type: | Organization |
Organization Name: | ST. VINCENT GENERAL HOSPITAL DISTRICT |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | REVENUE CYCLE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARCIA |
Authorized Official - Middle Name: | T |
Authorized Official - Last Name: | JENNINGS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 828-260-0476 |
Mailing Address - Street 1: | 816 W 4TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LEADVILLE |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80461-3861 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 719-486-0230 |
Mailing Address - Fax: | 719-486-1077 |
Practice Address - Street 1: | 822 W 4TH ST |
Practice Address - Street 2: | |
Practice Address - City: | LEADVILLE |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80461-3861 |
Practice Address - Country: | US |
Practice Address - Phone: | 719-486-0230 |
Practice Address - Fax: | 719-486-1077 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ST. VINCENT GENERAL HOSPITAL DISTRICT |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2022-05-12 |
Last Update Date: | 2022-05-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |