1023099454 NPI number — STANLY MEDICAL SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023099454 NPI number — STANLY MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANLY MEDICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023099454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 YADKIN ST
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
ALBEMARLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-983-7320
Provider Business Mailing Address Fax Number:
704-983-6153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 YADKIN ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
ALBEMARLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-983-5195
Provider Business Practice Location Address Fax Number:
704-982-2665
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
MARINDY
Authorized Official Middle Name:
BOST
Authorized Official Title or Position:
MANAGER REVENUE CYCLE
Authorized Official Telephone Number:
704-983-7320

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 790200F , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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