MEDICARE: RICHARD LINDELL RANDOL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	26852	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00153183	OTHER	SC	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20034153	OTHER	SC	SELECT HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	576007863	OTHER	SC	BLUE CHOICE
5	576007863	OTHER	SC	TRICARE

General Provider Information

NPI Number	:	1366541435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LINDELL RANDOL MD

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 VERDAE BLVD STE 101
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29607-4098
Country	:	US
Telephone Number	:	864-286-7550
Fax Number	:	864-286-7551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	03/07/2023

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Directions to “ RICHARD LINDELL RANDOL MD” Practice Location

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