Provider Demographics
NPI:1073718094
Name:RANDOLPH HOSPITAL INC.
Entity Type:Organization
Organization Name:RANDOLPH HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNWOOD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-625-5151
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-1048
Mailing Address - Country:US
Mailing Address - Phone:336-328-3442
Mailing Address - Fax:
Practice Address - Street 1:364 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5434
Practice Address - Country:US
Practice Address - Phone:336-328-3442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001702133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340123Medicare ID - Type UnspecifiedMEDICARE PROVIDER