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General NPI Number Information
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NPI Number | 1639755945
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Entity Type | Organization
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Legal Business Name | RANDALLS FAMILY HEALTH CARE
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 7415 ARAIA DR
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City | FOUNTAIN
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State | CO
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Zip | 80817-1590
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Country | US
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Telephone | 863-224-2903
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Fax | 866-256-5098
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Provider Business Mailing Address
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Address Line | 7415 ARAIA DR
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City | FOUNTAIN
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State | CO
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Zip | 80817-1590
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Country | US
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Telephone | 863-224-2903
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Fax | 866-256-5098
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Authorized Official
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Title or Position | OWNER
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Name | ADAM RANDALL
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Credential |
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Telephone | 863-224-2903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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