Provider Demographics
NPI:1144491770
Name:STANLY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:STANLY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARINDY
Authorized Official - Middle Name:B
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 1:320 YADKIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3447
Practice Address - Country:US
Practice Address - Phone:704-983-7320
Practice Address - Fax:704-983-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RG0100X
207QB0002X, 208800000X, 207RP1001X, 207V00000X, 207XX0005X, 208000000X, 208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914519Medicaid
NC2317250DOtherMEDICARE