Healthcare Provider Details

I. General information

NPI: 1851548002
Provider Name (Legal Business Name): MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 BREWER ST
ASHEBORO NC
27203-4896
US

IV. Provider business mailing address

1831 N FAYETTEVILLE ST
ASHEBORO NC
27203-3273
US

V. Phone/Fax

Practice location:
  • Phone: 336-610-7000
  • Fax:
Mailing address:
  • Phone: 336-672-1300
  • Fax: 336-672-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: WANDA S LYNTHACUM
Title or Position: MEDICAL BILLING SPECIALIST
Credential:
Phone: 336-301-2150