St. Vincent General Hospital District
Organization Active NPI Multi-Specialty Clinic/Center · Leadville, CO
NPI 1083351969 · NPPES record last updated Aug 27, 2024
Key facts
- NPI
- 1083351969
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- ST. VINCENT GENERAL HOSPITAL DISTRICT
- Practice address
- 822 W 4TH St
Leadville, CO 80461-3861 - Phone
- (719) 486-0230
- Fax
- (719) 486-1077
- NPI assigned
- May 12, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- ST. VINCENT GENERAL HOSPITAL DISTRICT
Authorized official
- Name
- Andrew Dreesen
- Title
- Authorized Official
- Phone
- (719) 486-7161
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 8
Practitioners 5
-
Dana Lynn Greene, MD
-
Amy Marie King, PA-C
-
Gary D Kliewer, C.R.N.A.
-
Steve D. Stahl, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D1042503 | St Vincent Family Health Clinic/Center | Certificate of waiver | Oct 24, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040316001421 | CO | Part B Supplier - Clinic/Group Practice | 4587574884 |
Receives reassigned benefits from 54 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Leadville, CO |
National Provider Directory
- Tax ID family
- St Vincent General Hospital District
- Part of
- St Vincent General Hospital District
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
822 W 4TH St
Leadville, CO 80461-3861
Mailing address
816 W 4TH St
Leadville, CO 80461-3861
Phone (719) 486-0230
Other names
- St. Vincent Health
Other providers in Leadville, CO
- Sayer-McKee Drug Store
- Lance A Schamberger
- Roberta L Seibel
- Heidi Skogman
- St. Vincent General Hospital District
- St. Vincent General Hospital District
- St. Vincent General Hospital District
- St. Vincent General Hospital District
- St. Vincent General Hospital District
- St. Vincent General Hospital District
All providers in Leadville, CO · Multi-Specialty Clinic/Center in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.