MEDICARE: RANDALL JAMES MCGUIRE CFNP

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	363L00000X	Nurse Practitioner	R38567	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00224839	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM006G23	OTHER	NM	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	NM011928	OTHER	NM	BCBS

General Provider Information

NPI Number	:	1962481986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL JAMES MCGUIRE CFNP

Provider Business Mailing Address
First Line	:	PO BOX 1555
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88202-1555
Country	:	US
Telephone Number	:	575-208-0106
Fax Number	:	575-208-0700

Provider Business Practice Location Address
First Line	:	1627 S UNION AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-2656
Country	:	US
Telephone Number	:	575-621-2007
Fax Number	:	575-208-0700

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	11/20/2019

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