Healthcare Provider Details

I. General information

NPI: 1295840999
Provider Name (Legal Business Name): STAFFORD COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 SOUTH BUCKEYE STREET
STAFFORD KS
67578-0190
US

IV. Provider business mailing address

502 S BUCKEYE ST
STAFFORD KS
67578-2035
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 Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH093002
License Number StateKS

VIII. Authorized Official

Name: JO DUVALL
Title or Position: ASST. ADMINISTRATOR
Credential:
Phone: 620-234-5221