Healthcare Provider Details

I. General information

NPI: 1124294194
Provider Name (Legal Business Name): WEST STANLY IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 STANLY PKWY SUITE E
LOCUST NC
28097-7704
US

IV. Provider business mailing address

PO BOX 686
ALBEMARLE NC
28002-0686
US

V. Phone/Fax

Practice location:
  • Phone: 704-781-0003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BRIAN FREEMAN
Title or Position: PRESIDENT
Credential:
Phone: 704-984-4393