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General NPI Number Information
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NPI Number | 1801953088
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Entity Type | Organization
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Legal Business Name | MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY, INC.
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 1831 NORTH FAYETTEVILLE ST
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City | ASHEBORO
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State | NC
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Zip | 27203
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Country | US
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Telephone | 336-672-1300
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Fax | 336-672-3044
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Provider Business Mailing Address
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Address Line | 1831 N FAYETTEVILLE ST
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City | ASHEBORO
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State | NC
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Zip | 27203-3273
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Country | US
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Telephone | 336-672-1300
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Fax | 336-672-3044
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Authorized Official
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Title or Position | CREDITALING SPECIALIST
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Name | CATHY HURLEY
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Credential |
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Telephone | 336-672-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 29728
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200200805
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License Number State | NC
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