| Richard C Randolph Md Pa | |
|
348 Crossgates Blvd Suite 2200 Brandon MS 39042-2616 | |
| (601) 825-2466 | |
| (601) 824-8137 |
| Full Name | Richard C Randolph Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 348 Crossgates Blvd, Brandon, Mississippi |
| Authorized Official Name and Position | Richard C Randolph (PRESIDENT) |
| Authorized Official Contact | 6018252466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard C Randolph Md Pa 348 Crossgates Blvd Suite 2200 Brandon MS 39042-2616 Ph: (601) 825-2466 | Richard C Randolph Md Pa 348 Crossgates Blvd Suite 2200 Brandon MS 39042-2616 Ph: (601) 825-2466 |
| NPI Number | 1679672745 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 08/15/2011 |
| Medicare PECOS PAC ID | 2567483498 |
|---|---|
| Medicare Enrollment ID | O20051207000713 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679672745 | NPI | - | NPPES |
| 03920519 | Medicaid | MS | |
| DG3008 | Other | MS | PALMETTO GBA RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 10006 (Mississippi) | Primary |
| Provider Name | Richard C Randolph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275632325 PECOS PAC ID: 7618998543 Enrollment ID: I20051215000356 |
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