1881648103 NPI number — STRATFORD HOSPITAL DISTRICT

Table of content: (NPI 1881648103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881648103 NPI number — STRATFORD HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATFORD HOSPITAL DISTRICT
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:
Provider Other Organization Name Type Code:
6
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:
1881648103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/25/2006
NPI Reactivation Date:
11/21/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79084-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-396-2844
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 JOSEPHINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEETWATER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79556-3599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-236-6653
Provider Business Practice Location Address Fax Number:
325-236-6834
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
806-396-2844

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004645 . This is a "FACILITY ID NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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