Provider Demographics
NPI:1740360114
Name:ALAN STOCKARD PC
Entity type:Organization
Organization Name:ALAN STOCKARD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CONROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-633-1524
Mailing Address - Street 1:PO BOX 1572
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-1572
Mailing Address - Country:US
Mailing Address - Phone:540-639-6736
Mailing Address - Fax:540-633-1524
Practice Address - Street 1:101 PROFESSIONAL PARK DR SE
Practice Address - Street 2:SUITE 3
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6685
Practice Address - Country:US
Practice Address - Phone:540-951-4000
Practice Address - Fax:540-633-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09566Medicare ID - Type UnspecifiedGROUP NUMBER