Provider Demographics
NPI:1780602771
Name:CAIN, BIBB RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:BIBB
Middle Name:RANDALL
Last Name:CAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 KEYSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5265
Mailing Address - Country:US
Mailing Address - Phone:864-223-2500
Mailing Address - Fax:864-725-4707
Practice Address - Street 1:1325 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-725-4799
Practice Address - Fax:864-725-4707
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC133000Medicaid
SCB92374Medicare UPIN
SCB923741124Medicare PIN