Healthcare Provider Details

I. General information

NPI: 1760720684
Provider Name (Legal Business Name): STRATFORD HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 W 51ST AVE
AMARILLO TX
79109-6129
US

IV. Provider business mailing address

4033 W 51ST AVE
AMARILLO TX
79109-6129
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-4488
  • Fax: 806-353-0885
Mailing address:
  • Phone: 806-355-4488
  • Fax: 806-353-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 949-540-1249