Healthcare Provider Details

I. General information

NPI: 1801953088
Provider Name (Legal Business Name): MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 NORTH FAYETTEVILLE ST
ASHEBORO NC
27203
US

IV. Provider business mailing address

1831 N FAYETTEVILLE ST
ASHEBORO NC
27203-3273
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29728
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200200805
License Number StateNC

VIII. Authorized Official

Name: CATHY HURLEY
Title or Position: CREDITALING SPECIALIST
Credential:
Phone: 336-672-1300