Provider Demographics
NPI:1811201544
Name:STANFORD MEDICAL INC
Entity Type:Organization
Organization Name:STANFORD MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-227-1744
Mailing Address - Street 1:1117 SUNSET DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4080
Mailing Address - Country:US
Mailing Address - Phone:662-227-1744
Mailing Address - Fax:662-226-1116
Practice Address - Street 1:1117 SUNSET DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4080
Practice Address - Country:US
Practice Address - Phone:662-227-1744
Practice Address - Fax:662-226-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty