Provider Demographics
NPI:1366980427
Name:ST. VINCENT HOSPITAL
Entity type:Organization
Organization Name:ST. VINCENT HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-913-5201
Mailing Address - Street 1:465 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7670
Mailing Address - Country:US
Mailing Address - Phone:505-913-5000
Mailing Address - Fax:505-913-3698
Practice Address - Street 1:465 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7670
Practice Address - Country:US
Practice Address - Phone:505-913-5000
Practice Address - Fax:505-913-3698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTUS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-08
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000041733336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7590250001Medicare NSC