| |
1413 N Lafayette St Shelby NC 28150-3406 | |
(704) 487-4321 | |
(704) 487-9561 |
Full Name | |
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Speciality | Internal Medicine |
Location | 1413 N Lafayette St, Shelby, North Carolina |
Authorized Official Name and Position | Ian Patrick Stamp (PRESIDENT) |
Authorized Official Contact | 7044874321 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1149 Shelby NC 28151-1149 Ph: (704) 487-4321 | 1413 N Lafayette St Shelby NC 28150-3406 Ph: (704) 487-4321 |
NPI Number | 1770787277 |
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Provider Enumeration Date | 06/11/2007 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 5799757274 |
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Medicare Enrollment ID | O20040806000587 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770787277 | NPI | - | NPPES |
891171E | Medicaid | NC | |
1171E | Other | NC | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Ian P Stamp |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1912965583 PECOS PAC ID: 2567443021 Enrollment ID: I20040528001136 |
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