Provider Demographics
NPI:1073644928
Name:RANDY M. SLOAN FAMILY MEDICINE, P.A
Entity Type:Organization
Organization Name:RANDY M. SLOAN FAMILY MEDICINE, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-270-0997
Mailing Address - Street 1:14905 US HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3391
Mailing Address - Country:US
Mailing Address - Phone:910-270-0997
Mailing Address - Fax:
Practice Address - Street 1:14905 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3391
Practice Address - Country:US
Practice Address - Phone:910-270-0997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501103261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8977033Medicaid
NC77033OtherBCBS
NC8977033Medicaid
NC2215969DMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE