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General NPI Number Information
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NPI Number | 1053523571
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Entity Type | Individual
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Provider Name | MRS. MARGIE ANN RANDLES
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 350 S. 4TH STREET
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City | COSHOCTON
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State | OH
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Zip | 43812-2021
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Country | US
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Telephone | 740-623-0679
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Fax |
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Provider Business Mailing Address
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Address Line | 350 S. 4TH STREET
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City | COSHOCTON
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State | OH
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Zip | 43812-2021
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Country | US
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Telephone | 740-623-0679
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2409843
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License Number State | OH
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