Provider Demographics
NPI:1043343304
Name:STAFFORD HOSPITAL, LLC
Entity Type:Organization
Organization Name:STAFFORD HOSPITAL, LLC
Other - Org Name:STAFFORD HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1414
Mailing Address - Street 1:2300 FALL HILL AVE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3342
Mailing Address - Country:US
Mailing Address - Phone:540-741-1821
Mailing Address - Fax:540-741-1097
Practice Address - Street 1:101 HOSPITAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6200
Practice Address - Country:US
Practice Address - Phone:540-741-1821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA364695OtherANTHEM BC
VA234771OtherUNITED HEALTHCARE HMO, ONENET, MDPIA, OPTIMUM CHOICE
VA540519577002OtherTRICARE
VA0564123-038OtherCIGNA
VA614500700OtherDEPARTMENT OF LABOR
VA9447838OtherAETNA
VAHG2OtherCAREFIRST BC
VA0564123-038OtherCIGNA
VA=========Medicaid
VA490140Medicare Oscar/Certification
VA=========Medicaid