1497756886 NPI number — DR. GEORGE RALPH RANDALL MD

Table of content: MS. BROCHA EPSTEIN (NPI 1639428022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497756886 NPI number — DR. GEORGE RALPH RANDALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANDALL
Provider First Name:
GEORGE
Provider Middle Name:
RALPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497756886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 N EMPORIA ST
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67214-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-263-0296
Provider Business Mailing Address Fax Number:
316-684-3326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 S HILLSIDE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67211-2193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-684-2838
Provider Business Practice Location Address Fax Number:
316-684-3326
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  17060 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2745673005 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101370 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 101370 . This is a "WAL-MART" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200811 . This is a "HEALTH PARTNERS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 758 . This is a "PREFERRED HEALTH SYSTEMS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 10084850B . This is a "FIRST GUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 4070797 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 758 . This is a "PREFERRED PLUS OF KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com