Provider Demographics
NPI:1629049168
Name:STANLY ORTHOPAEDIC AND HAND SURGERY CLINIC, PA
Entity Type:Organization
Organization Name:STANLY ORTHOPAEDIC AND HAND SURGERY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HARJIT
Authorized Official - Middle Name:BALA
Authorized Official - Last Name:MAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-983-3314
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-1230
Mailing Address - Country:US
Mailing Address - Phone:704-983-3314
Mailing Address - Fax:704-983-3315
Practice Address - Street 1:816 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3404
Practice Address - Country:US
Practice Address - Phone:704-983-3314
Practice Address - Fax:704-983-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902733Medicaid
NC02733OtherBCBS
NC8902733Medicaid
NC0618320001Medicare NSC