Healthcare Provider Details

I. General information

NPI: 1558521088
Provider Name (Legal Business Name): RANDOLPH HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 WHITE OAK ST
ASHEBORO NC
27203-5434
US

IV. Provider business mailing address

364 WHITE OAK ST
ASHEBORO NC
27203-5434
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-5151
  • Fax: 336-328-4411
Mailing address:
  • Phone: 336-625-5151
  • Fax: 336-328-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number9900601
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number200601123
License Number StateNC

VIII. Authorized Official

Name: MR. LYNWOOD R WHITE
Title or Position: CFO
Credential:
Phone: 336-625-5151