Healthcare Provider Details

I. General information

NPI: 1215892450
Provider Name (Legal Business Name): RANDALLS FAMILY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 SERENITY DR
MEDFORD OR
97504-5356
US

IV. Provider business mailing address

7415 ARAIA DR
FOUNTAIN CO
80817-1590
US

V. Phone/Fax

Practice location:
  • Phone: 863-224-2903
  • Fax: 866-256-5098
Mailing address:
  • Phone: 863-224-2903
  • Fax: 866-256-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADAM RANDALL
Title or Position: OWNER/MEDICAL PROVIDER
Credential: DNP
Phone: 863-224-2903