Provider Demographics
NPI:1932135498
Name:STANLY NEUROLOGY, INC.
Entity Type:Organization
Organization Name:STANLY NEUROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-982-0122
Mailing Address - Street 1:923 N 2ND ST
Mailing Address - Street 2:STE 102
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3369
Mailing Address - Country:US
Mailing Address - Phone:704-982-0122
Mailing Address - Fax:704-982-0125
Practice Address - Street 1:923 N 2ND ST
Practice Address - Street 2:STE 102
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3369
Practice Address - Country:US
Practice Address - Phone:704-982-0122
Practice Address - Fax:704-982-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99-00131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC99-00131OtherNC MEDICAL LICENSE NUMBER
NC1185TOtherBLUE CROSS PROVIDER #
NCP00071547OtherRETIRED RAILROAD NUMBER
NC2318699OtherMEDICARE GROUP PTAN
NC046373OtherMCKESSON SUBMITTER NUMBER
NC891185TMedicaid
NC2264002AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NC891185TMedicaid