Provider Demographics
NPI:1093135063
Name:ST. VINCENT GENERAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ST. VINCENT GENERAL HOSPITAL DISTRICT
Other - Org Name:ST. VINCENT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ACCOMANDO
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-486-0230
Mailing Address - Street 1:822 W. 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3897
Mailing Address - Country:US
Mailing Address - Phone:719-486-0230
Mailing Address - Fax:719-486-7167
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:719-486-1264
Practice Address - Fax:719-486-7145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT GENERAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-17
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty