Provider Demographics
NPI:1871543215
Name:STANFORD HEALTH CARE
Entity type:Organization
Organization Name:STANFORD HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN-ABASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-974-8592
Mailing Address - Street 1:300 PASTEUR DRIVE
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000662282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1288115Medicaid
CO940057626Medicaid
ASHS810PMedicaid
CAZZZA4309ZOtherBLUE SHIELD
CAZZZP4328ZOtherBLUE SHLD-FACULTY PRACTIC
KS100643860BMedicaid
ID807248900Medicaid
CAHSP40441HMedicaid
NM000A0561Medicaid
WY116853300Medicaid
WA7102213Medicaid
CAZZR00441HMedicaid
CAHSC00441HMedicaid
OR034512Medicaid
HI244848Medicaid
AZ635477Medicaid
NV001188115Medicaid
AKHS811PMedicaid
HI244848Medicaid
AKHS811PMedicaid