Provider Demographics
NPI:1508403528
Name:ST VINCENT HOSPITAL
Entity Type:Organization
Organization Name:ST VINCENT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-607-0495
Mailing Address - Street 1:440 SAINT MICHAELS DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7637
Mailing Address - Country:US
Mailing Address - Phone:505-913-5363
Mailing Address - Fax:505-989-6409
Practice Address - Street 1:440 SAINT MICHAELS DR STE 150
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7637
Practice Address - Country:US
Practice Address - Phone:505-913-5363
Practice Address - Fax:505-989-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty