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General NPI Number Information
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NPI Number | 1619022779
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Entity Type | Organization
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Legal Business Name | RANDOLPH SPECIALTY GROUP PRACTICE
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 700 SUNSET AVE
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City | ASHEBORO
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State | NC
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Zip | 27203-5304
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Country | US
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Telephone | 336-626-4328
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Fax | 336-625-9941
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Provider Business Mailing Address
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Address Line | PO BOX 5418
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City | ASHEBORO
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State | NC
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Zip | 27204-5418
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Country | US
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Telephone | 336-625-2333
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Fax | 336-625-5511
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT SCOTT CLAUSER
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Credential |
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Telephone | 336-625-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | AS0054
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License Number State | NC
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