Provider Demographics
NPI:1649224825
Name:JONES COUNTY REGIONAL HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:JONES COUNTY REGIONAL HEALTHCARE SYSTEM
Other - Org Name:STAMFORD MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-773-2725
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79553-0911
Mailing Address - Country:US
Mailing Address - Phone:325-773-2725
Mailing Address - Fax:325-773-3781
Practice Address - Street 1:1601 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:TX
Practice Address - Zip Code:79553-6863
Practice Address - Country:US
Practice Address - Phone:325-773-2725
Practice Address - Fax:325-773-3781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONES COUNTY REGIONAL HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-20
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000043282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX450306Medicare Oscar/Certification