Provider Demographics
NPI:1427678507
Name:STAMFORD HOSPITAL DISTRICT
Entity type:Organization
Organization Name:STAMFORD HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-773-4805
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79553-0911
Mailing Address - Country:US
Mailing Address - Phone:325-773-4805
Mailing Address - Fax:325-773-4828
Practice Address - Street 1:1601 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:TX
Practice Address - Zip Code:79553-6863
Practice Address - Country:US
Practice Address - Phone:325-773-4805
Practice Address - Fax:325-773-4828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAMFORD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-20
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX411366401Medicaid