Provider Demographics
NPI:1891776936
Name:STANLY MEDICAL SERVICES
Entity type:Organization
Organization Name:STANLY MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARINDY
Authorized Official - Middle Name:BOST
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-983-7320
Mailing Address - Street 1:320 YADKIN ST
Mailing Address - Street 2:STE 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 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:NC
Practice Address - Zip Code:27306-9250
Practice Address - Country:US
Practice Address - Phone:910-439-1573
Practice Address - Fax:910-439-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0124ROtherBCBS
NC348931OtherMEDICARE A
NC348931AOtherMEDICAID A
NC348931COtherMEDICAID C
NC2317250DOtherMEDICARE C