Healthcare Provider Details

I. General information

NPI: 1376231381
Provider Name (Legal Business Name): RANDOLPH-MACON COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 HENRY ST
ASHLAND VA
23005-1647
US

IV. Provider business mailing address

304 HENRY ST
ASHLAND VA
23005-1647
US

V. Phone/Fax

Practice location:
  • Phone: 804-752-3215
  • Fax:
Mailing address:
  • Phone: 804-752-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name: HEATHER LYNN BAUBY
Title or Position: OFFICE DIRECTOR
Credential: LAT
Phone: 804-752-3215