Provider Demographics
NPI:1588898480
Name:STANLY MEDICAL SERVICES
Entity type:Organization
Organization Name:STANLY MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-983-8220
Mailing Address - Street 1:320 YADKIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3447
Mailing Address - Country:US
Mailing Address - Phone:704-983-7320
Mailing Address - Fax:704-983-6153
Practice Address - Street 1:929 N 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3363
Practice Address - Country:US
Practice Address - Phone:704-983-1805
Practice Address - Fax:704-982-5985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC021V8OtherBCBS
NC5911755Medicaid
NC5911755Medicaid