MEDICARE: MR. RANDY F MCCOLLOUGH 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	207RC0000X	Cardiovascular Disease Physician	H2585	TX
2	207RI0011X	Interventional Cardiology Physician	H2585	TX

General Provider Information

NPI Number	:	1972594281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDY F MCCOLLOUGH MD

Provider Business Mailing Address
First Line	:	7800 SHOAL CREEK BLVD
Second Line	:	SUITE 205N
City	:	AUSTIN
State	:	TX
Zip	:	78757-1098
Country	:	US
Telephone Number	:	512-206-4341
Fax Number	:	512-407-1947

Provider Business Practice Location Address
First Line	:	800 W CENTRAL TEXAS EXPY
Second Line	:	STE. 355
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1899
Country	:	US
Telephone Number	:	254-526-2085
Fax Number	:	254-526-9569

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	01/13/2022

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