Basic Information
| Provider Information | |||||||||
| NPI: | 1245366103 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STRATFORD HOSPITAL DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 106 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790840106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063962844 | ||||||||
| FaxNumber: | 8063962086 | ||||||||
| Practice Location | |||||||||
| Address1: | 1109 BEAVER ROAD | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063962844 | ||||||||
| FaxNumber: | 8063962086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 01/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | LANNING | ||||||||
| AuthorizedOfficialFirstName: | JIMMY | ||||||||
| AuthorizedOfficialMiddleName: | DEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | EMS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8063962844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STRATFORD HOSPITAL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | 211001 | TX | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.