Provider Demographics
NPI:1134647159
Name:STRATFORD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:STRATFORD HOSPITAL DISTRICT
Other - Org Name:STRATFORD FAMILY MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-750-0169
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79084-1189
Mailing Address - Country:US
Mailing Address - Phone:806-396-5568
Mailing Address - Fax:806-396-5930
Practice Address - Street 1:1220 PURNELL
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:TX
Practice Address - Zip Code:79084-0020
Practice Address - Country:US
Practice Address - Phone:806-396-5583
Practice Address - Fax:806-366-2713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRATFORD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-30
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0730207Q00000X
261Q00000X, 261QR1300X
TXAP110343363LF0000X
TXAP106739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty