| Stanford Medical Inc | |
|
1117 Sunset Dr Suite 101 Grenada MS 38901-4080 | |
| (662) 227-1744 | |
| (662) 226-1116 |
| Full Name | Stanford Medical Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1117 Sunset Dr, Grenada, Mississippi |
| Authorized Official Name and Position | James Keith Stanford (OWNER) |
| Authorized Official Contact | 6622271744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stanford Medical Inc 1117 Sunset Dr Suite 101 Grenada MS 38901-4080 Ph: (662) 227-1744 | Stanford Medical Inc 1117 Sunset Dr Suite 101 Grenada MS 38901-4080 Ph: (662) 227-1744 |
| NPI Number | 1811201544 |
|---|---|
| Provider Enumeration Date | 08/05/2010 |
| Last Update Date | 11/08/2010 |
| Medicare PECOS PAC ID | 4587859020 |
|---|---|
| Medicare Enrollment ID | O20101110000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811201544 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | James Stanford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033220512 PECOS PAC ID: 8820283369 Enrollment ID: I20101110000986 |
| Provider Name | Amber B Hankins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922767938 PECOS PAC ID: 8729471792 Enrollment ID: I20220215002686 |
| Provider Name | Joseph Andrew Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336901594 PECOS PAC ID: 6800236191 Enrollment ID: I20240503001152 |
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