MEDICARE: THOMAS JAMES STANCIK JR. D.O.

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	OS013318	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2794933	OTHER		UNITED HEALTHCARE
2	1969259	OTHER	PA	BLUE SHIELD
3	707500	OTHER		COVENTRY
4	703212	OTHER	PA	UPMC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053535989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JAMES STANCIK JR. D.O.

Provider Business Mailing Address
First Line	:	100 INNOVATION DRIVE
Second Line	:	SUITE 101
City	:	SLIPPERY ROCK
State	:	PA
Zip	:	16057-0000
Country	:	US
Telephone Number	:	724-794-4023
Fax Number	:	724-794-3675

Provider Business Practice Location Address
First Line	:	100 INNOVATION DRIVE
Second Line	:	SUITE 101
City	:	SLIPPERY ROCK
State	:	PA
Zip	:	16057-0000
Country	:	US
Telephone Number	:	724-794-4023
Fax Number	:	724-794-3675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	04/11/2011

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