MEDICARE: WEST STANLY IMAGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory
2	261QR0200X	Radiology Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00670112	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	020XF	OTHER	NC	BCBS OF NORTH

General Provider Information

NPI Number	:	1124294194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST STANLY IMAGING LLC

Provider Business Mailing Address
First Line	:	PO BOX 686
Second Line	:
City	:	ALBEMARLE
State	:	NC
Zip	:	28002-0686
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 STANLY PKWY
Second Line	:	SUITE E
City	:	LOCUST
State	:	NC
Zip	:	28097-7704
Country	:	US
Telephone Number	:	704-781-0003
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN FREEMAN
Credential	:
Telephone Number	:	704-984-4393

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	09/15/2021

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Directions to “WEST STANLY IMAGING LLC ” Practice Location

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