Provider Demographics
NPI:1174812507
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: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 1:923 N 2ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3317
Practice Address - Country:US
Practice Address - Phone:704-986-6662
Practice Address - Fax:704-986-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC024P4OtherBCBS
NC5917199Medicaid
NC5917199Medicaid