Provider Demographics
NPI:1811963556
Name:RANDOLPH RADIOLOGICAL ASSOC INC
Entity type:Organization
Organization Name:RANDOLPH RADIOLOGICAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MCNEILL
Authorized Official - Last Name:LEDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-629-6565
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-1430
Mailing Address - Country:US
Mailing Address - Phone:336-629-6565
Mailing Address - Fax:336-626-5640
Practice Address - Street 1:364 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5434
Practice Address - Country:US
Practice Address - Phone:336-629-6565
Practice Address - Fax:336-626-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39346174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2504OtherBLUE CROSS
NC8902504Medicaid
NC204254Medicare ID - Type Unspecified