Provider Demographics
NPI:1851548002
Name:MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY,INC.
Entity Type:Organization
Organization Name:MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY,INC.
Other - Org Name:MERCE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LYNTHACUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-301-2150
Mailing Address - Street 1:1831 N FAYETTEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-3273
Mailing Address - Country:US
Mailing Address - Phone:336-672-1300
Mailing Address - Fax:336-672-3044
Practice Address - Street 1:308 BREWER ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4896
Practice Address - Country:US
Practice Address - Phone:336-610-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL RESOURCE CENTER FOR RANDOLPH COUNTY,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790202AMedicaid