Provider Demographics
NPI:1952548869
Name:STAFFORD HOSPITAL, LLC
Entity Type:Organization
Organization Name:STAFFORD HOSPITAL, LLC
Other - Org Name:STAFFORD HOSPITAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIWALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1821
Mailing Address - Street 1:2300 FALL HILL AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3342
Mailing Address - Country:US
Mailing Address - Phone:540-741-1821
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6200
Practice Address - Country:US
Practice Address - Phone:540-741-1821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty