Provider Demographics
NPI:1295840999
Name:STAFFORD COUNTY HOSPITAL
Entity Type:Organization
Organization Name:STAFFORD COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-234-5221
Mailing Address - Street 1:502 S BUCKEYE ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:KS
Mailing Address - Zip Code:67578-2035
Mailing Address - Country:US
Mailing Address - Phone:620-234-5221
Mailing Address - Fax:620-234-5792
Practice Address - Street 1:502 SOUTH BUCKEYE STREET
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:KS
Practice Address - Zip Code:67578-0190
Practice Address - Country:US
Practice Address - Phone:620-234-5221
Practice Address - Fax:620-234-5792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH093002282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000042OtherBCBS- HOSPITAL
KS110930OtherBCBS PART B (ER)
KS100099380AMedicaid
KS100099380AMedicaid