Provider Demographics
NPI:1184894875
Name:JON S STANCIL
Entity type:Organization
Organization Name:JON S STANCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STANCIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:252-439-1150
Mailing Address - Street 1:1432 E FIRE TOWER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4105
Mailing Address - Country:US
Mailing Address - Phone:252-439-1150
Mailing Address - Fax:252-439-1152
Practice Address - Street 1:1432 E FIRE TOWER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4105
Practice Address - Country:US
Practice Address - Phone:252-439-1150
Practice Address - Fax:252-439-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC412213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0801AOtherBCBS
NC79-0801AMedicaid
NC0801AOtherBCBS
NCU73498Medicare UPIN
NC2433383Medicare PIN