Provider Demographics
NPI:1770555625
Name:STANCIL RANEY MEDICINE PA
Entity type:Organization
Organization Name:STANCIL RANEY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANCIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-327-3344
Mailing Address - Street 1:1475 HOGAN LN
Mailing Address - Street 2:SUITE #121
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8287
Mailing Address - Country:US
Mailing Address - Phone:501-327-3344
Mailing Address - Fax:501-327-2998
Practice Address - Street 1:1475 HOGAN LN
Practice Address - Street 2:SUITE #121
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8287
Practice Address - Country:US
Practice Address - Phone:501-327-3344
Practice Address - Fax:501-327-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-05
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6656207R00000X
ARC6670207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty