MEDICARE: COLUMBIA/HCA JOHN RANDOLPH, INC.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1841123106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA/HCA JOHN RANDOLPH, INC.

Provider Business Mailing Address
First Line	:	930 SOUTH AVE STE 2
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3620
Country	:	US
Telephone Number	:	804-520-8272
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 SOUTH AVE STE 2
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3620
Country	:	US
Telephone Number	:	804-520-8272
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH MAZZO
Credential	:
Telephone Number	:	804-514-7732

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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