Provider Demographics
NPI:1891750436
Name:ST. VINCENT GENERAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:ST. VINCENT GENERAL HOSPITAL DISTRICT
Other - Org Name:ST. VINCENT HOSPITAL (SWING BED)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
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:719-486-7183
Mailing Address - Street 1:822 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3861
Mailing Address - Country:US
Mailing Address - Phone:719-486-0230
Mailing Address - Fax:719-486-1077
Practice Address - Street 1:822 WEST 4TH STREET
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461
Practice Address - Country:US
Practice Address - Phone:719-486-0230
Practice Address - Fax:719-486-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
CO0185282NC0060X
CO010908282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05656160Medicaid
CO06Z319Medicare Oscar/Certification