Provider Demographics
NPI:1265475321
Name:BELT, RANDALL L (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:BELT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:LEE
Other - Last Name:BELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:378 MARKETPLACE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2361
Practice Address - Country:US
Practice Address - Phone:423-282-0751
Practice Address - Fax:423-282-1577
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1640207P00000X, 207Q00000X
WV1756207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5600582001Medicaid
WVP00285995OtherMEDICARE RAILROAD
WV000688219OtherBLUE CROSS
VA005645786Medicaid
KY6405640Medicaid
WVBE0892605Medicare ID - Type UnspecifiedMWV
WV5600582001Medicaid
WVBE0892605Medicare PIN
TN103I936977Medicare PIN
KY6405640Medicaid