Provider Demographics
NPI:1558578807
Name:JAMES G RANDOLPH
Entity Type:Organization
Organization Name:JAMES G RANDOLPH
Other - Org Name:BIG HORN BONE & JOINT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-347-8262
Mailing Address - Street 1:151 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-3339
Mailing Address - Country:US
Mailing Address - Phone:307-347-8265
Mailing Address - Fax:
Practice Address - Street 1:151 S 6TH ST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3339
Practice Address - Country:US
Practice Address - Phone:307-347-8265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5211A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW308041Medicare PIN
WYC20850Medicare UPIN
WY0741630001Medicare NSC
WYW308039Medicare PIN