Basic Information
Provider Information
NPI: 1902887045
EntityType: 2
ReplacementNPI:  
OrganizationName: STANLY MEDICAL SERVICES
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: NORWOOD MEDICAL SERVICES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 320 YADKIN ST
Address2: STE B
City: ALBEMARLE
State: NC
PostalCode: 280013447
CountryCode: US
TelephoneNumber: 7049837320
FaxNumber: 7049836153
Practice Location
Address1: 269 S MAIN ST
Address2:  
City: NORWOOD
State: NC
PostalCode: 281286435
CountryCode: US
TelephoneNumber: 7044743171
FaxNumber: 7044744031
Other Information
ProviderEnumerationDate: 11/07/2005
LastUpdateDate: 05/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HARRIS
AuthorizedOfficialFirstName: MARINDY
AuthorizedOfficialMiddleName: BOST
AuthorizedOfficialTitleorPosition: MANAGER REVENUE CYCLE
AuthorizedOfficialTelephone: 7049837320
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
890242H05NC MEDICAID
0242H01NCBCBSOTHER


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