1871543215 NPI number — STANFORD HEALTH CARE

Table of content: (NPI 1871543215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871543215 NPI number — STANFORD HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANFORD HEALTH CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STANFORD HOSPITAL AND CLINICS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871543215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 PASTEUR DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94305-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-723-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 PASTEUR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94305-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-723-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AMIN-ABASSI
Authorized Official First Name:
FATANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT MANAGER
Authorized Official Telephone Number:
510-974-8592

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  070000662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1288115 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 940057626 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZR00441H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116853300 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSP40441H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000A0561 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS810P , issued by the state of ( AS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001188115 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZP4328Z . This is a "BLUE SHLD-FACULTY PRACTIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 034512 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 244848 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS811P , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100643860B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 635477 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7102213 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA4309Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 807248900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSC00441H , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113333500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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