Stanford Medical Inc
Organization Active NPI Family Medicine Physician · Grenada, MS
NPI 1811201544 · NPPES record last updated Nov 8, 2010
Key facts
- NPI
- 1811201544
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- STANFORD MEDICAL INC
- Practice address
- 1117 Sunset Dr
Suite 101
Grenada, MS 38901-4080 - Phone
- (662) 227-1744
- Fax
- (662) 226-1116
- NPI assigned
- Aug 5, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. James Keith Stanford, M.D.
- Title
- Owner
- Phone
- (662) 227-1744
Practitioners 5
-
Kaitlin Renfro, FNP-C
-
James K Stanford, M.D.
-
Amber Brooke Hankins, FNP-C
-
Dustin Kelly, FNP-C
-
Joseph Frank Roberts, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D0966003 | Stanford Medical Inc | Certificate of waiver | Jul 13, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101110000934 | MS | Part B Supplier - Clinic/Group Practice | 4587859020 |
Receives reassigned benefits from 3 practitioners Practice locations: Grenada, MS |
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/24236/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1117 Sunset Dr
Suite 101
Grenada, MS 38901-4080
Mailing address
1117 Sunset Dr
Suite 101
Grenada, MS 38901-4080
Phone (662) 227-1744
Other providers in Grenada, MS
- Dion T Sones
- Southern Hospitality Adult Daycare, LLC
- Southside Medical Clinic, LLC
- Tonesha Spearman
- Speech Pathology Services
- James K Stanford
- State of Mississippi - University of Mississippi Medical Center
- State of Mississippi - University of Mississippi Medical Center
- State of Mississippi - University of Mississippi Medical Center
- State of Mississippi-University of Mississippi Medical Center
All providers in Grenada, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.