Healthcare Provider Details

I. General information

NPI: 1255328449
Provider Name (Legal Business Name): RANDOLPH HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/17/2008
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

PO BOX 1048
ASHEBORO NC
27204-1048
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-5151
  • Fax: 336-633-7764
Mailing address:
  • Phone: 336-625-5151
  • Fax: 336-633-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH0013
License Number StateNC

VIII. Authorized Official

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