Provider Demographics
NPI:1114968666
Name:JAMES, RANDALL H (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:H
Last Name:JAMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 1ST AVE
Mailing Address - Street 2:HIGHAWN MEDICAL BUILDING, STE 504
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-399-7212
Mailing Address - Fax:304-399-7215
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:HIGHAWN MEDICAL BUILDING, STE 504
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-399-7212
Practice Address - Fax:304-399-7215
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111718208100000X
MI5101017513208100000X
WV2401208100000X
OH6154208100000X
HIDOS-750208100000X
IN02003421A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000274617OtherUNISON
WV3810014936Medicaid
OH2955299Medicaid
WV1074767OtherWV COMPENSATION
WV2110724OtherMTN ST BCBS
WV5045645OtherAETNA
KY7100077570Medicaid
WV3810014936Medicaid
OH000000274617OtherUNISON
WV5045645OtherAETNA
ILK18907Medicare ID - Type Unspecified
WVPO0768191Medicare PIN