Provider Demographics
NPI:1922150812
Name:COUNTY OF STANLY
Entity Type:Organization
Organization Name:COUNTY OF STANLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SUPPORT III
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-986-3650
Mailing Address - Street 1:201 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5747
Mailing Address - Country:US
Mailing Address - Phone:704-986-3650
Mailing Address - Fax:704-986-9653
Practice Address - Street 1:201 S 2ND ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5747
Practice Address - Country:US
Practice Address - Phone:704-986-3650
Practice Address - Fax:704-986-3653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF STANLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1329341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0722EOtherBCBS OF NC
NC3406921Medicaid
NC0722EOtherBCBS OF NC