Provider Demographics
NPI:1831493584
Name:ST. VINCENT HOSPITAL
Entity Type:Organization
Organization Name:ST. VINCENT HOSPITAL
Other - Org Name:CHRISTUS ST. VINCENT BEHAVIORAL HEALTH SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-820-5202
Mailing Address - Street 1:440 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7602
Mailing Address - Country:US
Mailing Address - Phone:505-913-3056
Mailing Address - Fax:505-989-6021
Practice Address - Street 1:440 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7602
Practice Address - Country:US
Practice Address - Phone:505-913-3056
Practice Address - Fax:505-989-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14-001237612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM95895314Medicaid
NM100521049Medicare PIN