Provider Demographics
NPI:1881777076
Name:STRATFORD HOSPITAL DISTRICT
Entity type:Organization
Organization Name:STRATFORD HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:806-366-5505
Mailing Address - Street 1:317 N. MAIN ST.
Mailing Address - Street 2:P.O. BOX 166
Mailing Address - City:STRATFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79084
Mailing Address - Country:US
Mailing Address - Phone:806-366-5505
Mailing Address - Fax:806-396-2277
Practice Address - Street 1:317 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:TX
Practice Address - Zip Code:79084
Practice Address - Country:US
Practice Address - Phone:806-366-5505
Practice Address - Fax:806-396-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
TX261333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX250482Medicaid
2096171OtherPK
TX142008Medicaid