Healthcare Provider Details

I. General information

NPI: 1982845194
Provider Name (Legal Business Name): RANDOLPH HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
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: 336-626-7664
Mailing address:
  • Phone: 336-625-5151
  • Fax: 336-626-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

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