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NPI Code Detail

MEDICARE: STANLY MEDICAL SERVICES

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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20242HOTHERNCBCBS

General Provider Information

NPI Number : 1902887045
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 : 269 S MAIN ST
Second Line :
City : NORWOOD
State : NC
Zip : 28128-6435
Country : US
Telephone Number : 704-474-3171
Fax Number : 704-474-4031
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 : 05/07/2014

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Directions to “STANLY MEDICAL SERVICES ” Practice Location

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