Provider Demographics
NPI:1982753711
Name:STANFORD HOSPITAL AND CLINICS
Entity Type:Organization
Organization Name:STANFORD HOSPITAL AND CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-723-8542
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANFORD HOSPITAL AND CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000662283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR034512Medicaid
KS100643860BMedicaid
CAZZR00441HMedicaid
CAZZZA4309ZOtherBLUE SHIELD OF CA
NV1288115Medicaid
AZ635477Medicaid
NV001188115Medicaid
HI244848Medicaid
ASHS810PMedicaid
CAHSC00441HMedicaid
NM000A0561Medicaid
CO940057626Medicaid
AKHS811PMedicaid
WY116853300Medicaid
WA7102213Medicaid
MO4103358Medicaid
TX050411Medicaid
FL092494300Medicaid
CAZZR00441HMedicaid
HI244848Medicaid