Stanly Medical Services
Organization Active NPI Pediatrics Physician · Locust, NC
NPI 1821079963 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1821079963
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- STANLY MEDICAL SERVICES
- Practice address
- 103 Stanly Pkwy
Ste a
Locust, NC 28097-7704 - Phone
- (704) 888-8445
- Fax
- (704) 888-8456
- NPI assigned
- Nov 7, 2005
- Organization subpart
- No
Authorized official
- Name
- Douglas Scott Forth
- Title
- Ceo
- Phone
- (704) 983-8756
Corporate family (same tax ID) 4
National Provider Directory
- Tax ID family
- Stanly Medical Services
Locations
103 Stanly Pkwy
Ste A
Locust, NC 28097
Phone (704) 888-0580
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes |
Addresses
Primary practice location
103 Stanly Pkwy
Ste a
Locust, NC 28097-7704
Mailing address
320 Yadkin St
Ste B
Albemarle, NC 28001-3447
Phone (704) 982-0639
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89015PK | Medicaid | NC |
Other names
- Stanly Pediatric Services at Locust
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All providers in Locust, NC · Pediatrics Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.