Provider Demographics
NPI:1356331425
Name:STAMFORD HOSPITAL
Entity Type:Organization
Organization Name:STAMFORD HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR - FINANCIAL PLAN & R
Authorized Official - Prefix:
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-276-7464
Mailing Address - Street 1:1 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-276-1000
Mailing Address - Fax:203-276-7093
Practice Address - Street 1:1 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-1000
Practice Address - Fax:203-276-7093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059208M00000X, 282N00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00013OtherMEDICARE PART B PROVIDER
CTC00013OtherMEDICARE PART B PROVIDER