Healthcare Provider Details

I. General information

NPI: 1639755945
Provider Name (Legal Business Name): RANDALLS FAMILY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7415 ARAIA DR
FOUNTAIN CO
80817-1590
US

IV. Provider business mailing address

7415 ARAIA DR
FOUNTAIN CO
80817-1590
US

V. Phone/Fax

Practice location:
  • Phone: 863-224-2903
  • Fax: 866-256-5098
Mailing address:
  • Phone: 863-224-2903
  • Fax: 866-256-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADAM RANDALL
Title or Position: OWNER
Credential:
Phone: 863-224-2903