Provider Demographics
| NPI: | 1437292927 |
|---|---|
| Name: | STANFORD HEALTH CARE |
| Entity Type: | Organization |
| Organization Name: | STANFORD HEALTH CARE |
| Other - Org Name: | STANFORD HOSPITAL AND CLINICS |
| Other - Org Type: | Former Legal Business Name |
| Authorized Official - Title/Position: | CHIEF REVENUE CYCLE OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JILL |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | BUATHIER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 650-723-4000 |
| Mailing Address - Street 1: | 7999 GATEWAY BLVD STE 200 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | NEWARK |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 94560-1197 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 650-723-4000 |
| Mailing Address - Fax: | 650-498-5840 |
| Practice Address - Street 1: | 300 PASTEUR DRIVE |
| Practice Address - Street 2: | |
| Practice Address - City: | STANFORD |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 94305 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 650-723-4000 |
| Practice Address - Fax: | 650-498-5840 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-02-14 |
| Last Update Date: | 2021-09-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | ||
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| IL | 095552 | Medicaid | |
| OR | 034512 | Medicaid | |
| AR | H5810P | Medicaid | |
| MT | 4103358 | Medicaid | |
| ID | 807248900 | Medicaid | |
| NM | 000A0561 | Medicaid | |
| NV | 1288115 | Medicaid | |
| AK | HS810P | Medicaid | |
| ID | 807248900 | Medicaid |
