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NPI Code Detail

MEDICARE: MR. RANDY LEON ZANDERS JR.

MEDICARE:  MR. RANDY LEON ZANDERS JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1341600000XAmbulance

General Provider Information

NPI Number : 1699952234
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDY LEON ZANDERS JR.
Provider Business Mailing Address
First Line : 1439 JOHNSVILLE HWY
Second Line :
City : LAKE CITY
State : SC
Zip : 29560
Country : US
Telephone Number : 843-394-7490
Fax Number : 843-394-7479
Provider Business Practice Location Address
First Line : 1439 JOHNSONVILLE HIGHWAY
Second Line :
City : LAKE CITY
State : SC
Zip : 29560-2523
Country : US
Telephone Number : 843-394-7490
Fax Number : 843-394-7479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2008
Last Update Date : 01/25/2008

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Directions to “ MR. RANDY LEON ZANDERS JR. ” Practice Location

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