Provider Demographics
NPI:1033717376
Name:TAYLOR, RANDALL LEE SR
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:LEE
Last Name:TAYLOR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 TRISHA TRL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3460
Mailing Address - Country:US
Mailing Address - Phone:804-234-6043
Mailing Address - Fax:
Practice Address - Street 1:4046 TRISHA TRL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3460
Practice Address - Country:US
Practice Address - Phone:804-234-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)