Basic Information
| Provider Information | |||||||||
| NPI: | 1144491770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STANLY MEDICAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 YADKIN ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280013447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049837320 | ||||||||
| FaxNumber: | 7049836153 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 YADKIN ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280013447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049837320 | ||||||||
| FaxNumber: | 7049836153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2008 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | MARINDY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 7049837320 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | NC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207QB0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine | 208800000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207XX0005X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5914519 | 05 | NC | MEDICAID | 2317250D | 01 | NC | MEDICARE | OTHER |