25D0966003 CLIA NUMBER - STANFORD MEDICAL INC

Laboratory Demographics

  • CLIA Code: 25D0966003
  • Facility Name: STANFORD MEDICAL INC
  • Facility Address: 1117 SUNSET DRIVE SUITE 101
    GRENADA, MS
    ZIP 38901
  • Facility Phone: 662 227-1744
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES K. STANFORD MD
  • NPI Number: 1811201544
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D0966003
LAB Type Physician Office
Facility Name STANFORD MEDICAL INC
Street 1117 SUNSET DRIVE SUITE 101
City GRENADA
State MS
ZIP 38901
Phone 662 227-1744
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2024
Certificate Expiration Date 7/13/2026
Facility Type Physician Office
Lab Director JAMES K. STANFORD MD

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This page was last updated on: 9/29/2025