Provider Demographics
NPI:1891750436
Name:ST. VINCENT GENERAL HOSPITAL DISTRICT
Entity type:Organization
Organization Name:ST. VINCENT GENERAL HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DREESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-486-7161
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 1:816 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3861
Practice Address - Country:US
Practice Address - Phone:719-486-0230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0185282NC0060X
CO010908282NC0060X
275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05656160Medicaid
CO06Z319Medicare Oscar/Certification