Provider Demographics
NPI:1477810265
Name:RANDLEMAN MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:RANDLEMAN MEDICAL CLINIC, LLC
Other - Org Name:RANDLEMAN MEDICAL CENTER, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-498-8500
Mailing Address - Street 1:670 W ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-9748
Mailing Address - Country:US
Mailing Address - Phone:336-498-8500
Mailing Address - Fax:336-498-8522
Practice Address - Street 1:670 W ACADEMY ST
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-9748
Practice Address - Country:US
Practice Address - Phone:336-498-8500
Practice Address - Fax:336-498-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920523Medicaid
NC1710920335OtherNPI