Provider Demographics
NPI:1629153622
Name:JAMES G RANDOLPH MD
Entity Type:Organization
Organization Name:JAMES G RANDOLPH MD
Other - Org Name:BIG HORN BONE AND JOINT CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D., 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:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-0463
Mailing Address - Country:US
Mailing Address - Phone:307-347-8262
Mailing Address - Fax:307-347-8265
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:307-347-8262
Practice Address - Fax:307-347-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY102379900Medicaid
WY102379900Medicaid
WY200016320Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
WYW308039Medicare PIN