Basic Information
| Provider Information | |||||||||
| NPI: | 1134276413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TENNANT | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | NEAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 N CHURCH ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362726133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1002 N CHURCH ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362726133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 08/27/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 26995 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 060042000 | 01 | RR MEDICARE | OTHER | 82409 | 01 | NC | BCBS NC | OTHER | 437 | 01 | PARTNERS MEDICARE | OTHER | 2500041 | 01 | UNITED HEALTHCARE | OTHER | 437 | 01 | PARTNERS | OTHER | 561240263 | 01 | COMMERCIAL | OTHER | 8982409 | 05 | NC | MEDICAID |