Provider Demographics
NPI:1467498329
Name:JOHN H STANLEY M.D.LLC
Entity Type:Organization
Organization Name:JOHN H STANLEY M.D.LLC
Other - Org Name:JOHN H STANLEY M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:STANLEY MD LLC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-561-2533
Mailing Address - Street 1:8080 WARD PARKWAY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:KANSAS
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2020
Mailing Address - Country:US
Mailing Address - Phone:816-561-2533
Mailing Address - Fax:
Practice Address - Street 1:8080 WARD PARKWAY
Practice Address - Street 2:SUITE 113
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2020
Practice Address - Country:US
Practice Address - Phone:816-561-2533
Practice Address - Fax:815-444-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200763027Medicaid