Provider Demographics
NPI:1497788608
Name:RANDALL HILE MD PC
Entity Type:Organization
Organization Name:RANDALL HILE MD PC
Other - Org Name:RANDALL HILE MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-696-0779
Mailing Address - Street 1:6105 W 177TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1971
Mailing Address - Country:US
Mailing Address - Phone:219-696-0779
Mailing Address - Fax:219-696-4629
Practice Address - Street 1:1020 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-2310
Practice Address - Country:US
Practice Address - Phone:219-696-3052
Practice Address - Fax:219-696-4629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030234A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200900500Medicaid
IN000000085930OtherBLUE CROSS BLUE SHIELD
IN110007891OtherRAILROAD MEDICARE
IN706810Medicare PIN