Basic Information
| Provider Information | |||||||||
| NPI: | 1215274758 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STANLY MEDICAL SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | LOCUST URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 103 STANLY PKWY | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LOCUST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280977710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048880580 | ||||||||
| FaxNumber: | 7047810360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2013 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | MARINDY | ||||||||
| AuthorizedOfficialMiddleName: | BOST | ||||||||
| 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 | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.