Provider Demographics
NPI:1467260869
Name:STANCIL, GLENWOOD SHELTON JR (NBC-HWC, RT(R)(CT))
Entity type:Individual
Prefix:MR
First Name:GLENWOOD
Middle Name:SHELTON
Last Name:STANCIL
Suffix:JR
Gender:M
Credentials:NBC-HWC, RT(R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 E HIGHWAY WW
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8771
Mailing Address - Country:US
Mailing Address - Phone:573-787-4600
Mailing Address - Fax:
Practice Address - Street 1:6720 E HIGHWAY WW
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8771
Practice Address - Country:US
Practice Address - Phone:573-787-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2417322471C3401X, 2471C3402X
A-3986249171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography