Provider Demographics
NPI:1720122856
Name:STANFORD UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:STANFORD UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR -G.S. RESIDENCY PROGRAM
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-736-1250
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:ROOM H3691
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-736-1250
Mailing Address - Fax:650-724-9806
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:ROOM H3691
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-736-1250
Practice Address - Fax:650-724-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85803282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G858030Medicaid
CA00G858030Medicaid
CA00G858030Medicare ID - Type Unspecified