Provider Demographics
NPI:1982647277
Name:MCGILL, RANDALL L (CRNA)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:MCGILL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 JERICHO RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-4251
Mailing Address - Country:US
Mailing Address - Phone:304-347-1094
Mailing Address - Fax:
Practice Address - Street 1:4537 JERICHO RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-4251
Practice Address - Country:US
Practice Address - Phone:304-347-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29304367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00000000OtherRETIRED
OH2263689Medicaid
WVP00168008OtherRR MEDICARE
WV8228522Medicare PIN
WV9333201Medicare PIN
WV001706470OtherMSBCBS GROUP
WV0207026000Medicaid
WV000690017OtherBCBS
WV2602173000Medicaid
WV27005299700OtherBRICKSTREET
WV270052997003OtherTRICARE
WVDA0096OtherRR MEDICARE