Provider Demographics
NPI:1104005602
Name:STIBAL SURGICAL CENTER
Entity type:Organization
Organization Name:STIBAL SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STIBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-983-3500
Mailing Address - Street 1:303C YADKIN ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3441
Mailing Address - Country:US
Mailing Address - Phone:704-983-3500
Mailing Address - Fax:704-983-3763
Practice Address - Street 1:303C YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-983-3500
Practice Address - Fax:704-983-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32583208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC80035OtherBCBSNC
NC8980035Medicaid
NC2319836Medicare PIN
NC80035OtherBCBSNC