Provider Demographics
NPI:1285829366
Name:ST VINCENT HOSPITAL
Entity Type:Organization
Organization Name:ST VINCENT HOSPITAL
Other - Org Name:CHRISTUS ST. VINCENT WOMEN'S CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-913-5202
Mailing Address - Street 1:2055 S PACHECO ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-0504
Mailing Address - Country:US
Mailing Address - Phone:505-984-0303
Mailing Address - Fax:505-984-1116
Practice Address - Street 1:465 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-984-0303
Practice Address - Fax:505-984-1116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84074043Medicaid
NM84074043Medicaid