Healthcare Provider Details

I. General information

NPI: 1215256995
Provider Name (Legal Business Name): STAFFORD COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 GRAND AVE
STAFFORD KS
67578-2010
US

IV. Provider business mailing address

412 GRAND AVE PO BOX 190
STAFFORD KS
67578-2010
US

V. Phone/Fax

Practice location:
  • Phone: 620-234-5221
  • Fax: 620-234-5792
Mailing address:
  • Phone: 620-234-5221
  • Fax: 620-234-5792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO ORTIZ
Title or Position: CEO
Credential:
Phone: 620-234-5221