Provider Demographics
NPI:1538100136
Name:STAMFORD HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:STAMFORD HOSPITAL DISTRICT
Other - Org Name:MEMORIAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BIRGITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-773-2725
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79553-0910
Mailing Address - Country:US
Mailing Address - Phone:325-773-5733
Mailing Address - Fax:325-773-3781
Practice Address - Street 1:1601 COLUMBIA ST STE A
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:TX
Practice Address - Zip Code:79553
Practice Address - Country:US
Practice Address - Phone:325-773-5733
Practice Address - Fax:325-773-3781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAMFORD HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458611Medicare ID - Type UnspecifiedMEMORIAL HEALTH CLINIC