Healthcare Provider Details

I. General information

NPI: 1770555625
Provider Name (Legal Business Name): STANCIL RANEY MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 HOGAN LN SUITE #121
CONWAY AR
72034-8287
US

IV. Provider business mailing address

1475 HOGAN LN SUITE #121
CONWAY AR
72034-8287
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-3344
  • Fax: 501-327-2998
Mailing address:
  • Phone: 501-327-3344
  • Fax: 501-327-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberC6670
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC6656
License Number StateAR

VIII. Authorized Official

Name: DR. VICKI L STANCIL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-327-3344