Provider Demographics
NPI:1902887045
Name:STANLY MEDICAL SERVICES
Entity Type:Organization
Organization Name:STANLY MEDICAL SERVICES
Other - Org Name:NORWOOD MEDICAL SERVICES
Other - Org Type:Doing Business As
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 1:269 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NC
Practice Address - Zip Code:28128-6435
Practice Address - Country:US
Practice Address - Phone:704-474-3171
Practice Address - Fax:704-474-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890242HMedicaid
NC0242HOtherBCBS
NC2317250DMedicare PIN
NC348949AMedicaid
NC378949CMedicaid
NC2317250DMedicare PIN