Provider Demographics
NPI:1528392289
Name:RANDOLPH PRIMARY CARE, PA
Entity Type:Organization
Organization Name:RANDOLPH PRIMARY CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-629-2201
Mailing Address - Street 1:350 N COX ST STE 6
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5514
Mailing Address - Country:US
Mailing Address - Phone:336-629-2201
Mailing Address - Fax:336-629-2205
Practice Address - Street 1:350 N COX ST STE 6
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5514
Practice Address - Country:US
Practice Address - Phone:336-629-2201
Practice Address - Fax:336-629-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913171Medicaid
NC5913171Medicaid