MEDICARE: STANLY MEDICAL SERVICES

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	207Q00000X	Family Medicine Physician

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	0229J	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1871574921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLY MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	320 YADKIN ST
Second Line	:	STE B
City	:	ALBEMARLE
State	:	NC
Zip	:	28001-3447
Country	:	US
Telephone Number	:	704-983-7320
Fax Number	:	704-983-6153

Provider Business Practice Location Address
First Line	:	103 STANLY PKWY
Second Line	:	SUITE A
City	:	LOCUST
State	:	NC
Zip	:	28097-7710
Country	:	US
Telephone Number	:	704-888-0580
Fax Number	:	704-888-0602

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/15/2013

Similar Medicare Providers

1215274758 — STANLY MEDICAL SERVICES
Practice Location Address:

103 STANLY PKWY , SUITE C
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1619371697 — CAROLINAS PHYSICIANS NETWORK, INC.
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1649268459 — DR. RICARDO VARGAS M.D.
Practice Location Address:

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1902894041 — DR. JASON F BAKER DDS
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1821079963 — STANLY MEDICAL SERVICES
Practice Location Address:

103 STANLY PKWY , STE A
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28097-7704

Practice Phone: 704-888-8445
Practice Fax: 704-888-8456

Directions to “STANLY MEDICAL SERVICES ” Practice Location

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