Basic Information
| Provider Information | |||||||||
| NPI: | 1689646168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANLEY | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 W 69TH ST | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571088170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053225700 | ||||||||
| FaxNumber: | 6053225704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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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 | 2084P0800X | 3964 | SD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 040121002 | 01 | MN | PRIMEWEST | OTHER | 3148379 | 05 | IA | MEDICAID | 370624200 | 01 | SD | DEPT OF LABOR | OTHER | 46022474352 | 05 | NE | MEDICAID | 25054 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 7100963 | 05 | SD | MEDICAID | 12200 | 05 | ND | MEDICAID | 241L8ST | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 6438 | 01 | SD | MIDLANDS CHOICE | OTHER | HP32074 | 01 | SD | HEALTHPARTNERS | OTHER | 412991017061 | 01 | SD | PREFERRED ONE | OTHER | 57108C021 | 01 | SD | WPS TRICARE | OTHER | 3964 | 01 | SD | DAKOTACARE | OTHER | 619014600 | 05 | MN | MEDICAID | 23018 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 4995812 | 01 | SD | BLUE CROSS | OTHER |