Provider Demographics
NPI:1255328449
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:336-625-5151
Mailing Address - Fax:336-633-7764
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:336-625-5151
Practice Address - Fax:336-633-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0013282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1419YOtherBC BS OF NC DIABETES
NC00453OtherBLUE CROSS
NC3400123Medicaid
NC0770HOtherBLUE SHIELD
NC235134Medicare PIN
NC00453OtherBLUE CROSS
NC340123Medicare ID - Type Unspecified