Provider Demographics
NPI:1598882797
Name:ST. VINCENT HOSPITAL
Entity Type:Organization
Organization Name:ST. VINCENT HOSPITAL
Other - Org Name:ALAN ROGERS, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-820-5227
Mailing Address - Street 1:455 SAINT MICHAELS DR
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7601
Mailing Address - Country:US
Mailing Address - Phone:505-820-8227
Mailing Address - Fax:505-820-5440
Practice Address - Street 1:530 HARKLE RD SUITE A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4713
Practice Address - Country:US
Practice Address - Phone:505-983-6911
Practice Address - Fax:505-983-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14943OtherMOLINA
NM002A08OtherBLUE CROSS BLUE SHIELD
NM45690Medicaid
10001164OtherLOVELACE HEALTHCARE