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General NPI Number Information
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NPI Number | 1376231381
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Entity Type | Organization
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Legal Business Name | RANDOLPH-MACON COLLEGE
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 304 HENRY ST
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City | ASHLAND
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State | VA
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Zip | 23005-1647
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Country | US
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Telephone | 804-752-3215
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Fax |
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Provider Business Mailing Address
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Address Line | 304 HENRY ST
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City | ASHLAND
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State | VA
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Zip | 23005-1647
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Country | US
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Telephone | 804-752-3215
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Fax |
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Authorized Official
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Title or Position | OFFICE DIRECTOR
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Name | HEATHER LYNN BAUBY
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Credential | LAT
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Telephone | 804-752-3215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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