Organization
RANDOLPH MEDICAL ASSOCIATES
Active
Parent organization
RANDOLPH MEDICAL ASSOCIATES
Other names
IMAGING MOBILITY UNIT
Organization subpart
Yes
Provider details
NPI number
Legal business name
RANDOLPH MEDICAL ASSOCIATES
Authorized official
DR. RUSSELL DOAK PETERSON DO (OWNER)
(334) 863-2150
Entity
Organization
Contact information
Practice address
965 US HWY 431, ROANOKE, AL 36274
(334) 863-2150
(334) 863-8733
Mailing address
PO BOX 625, ROANOKE, AL 36274-0625
(334) 863-2150
(334) 863-8733
Taxonomy
Speciality
Code
Description
License number
State
246XS1301X
Sonography Specialist/Technologist Cardiovascular
Primary
D0436
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51091244
BCBS
AL
01
—
E26656
UPIN
AL
Enumeration date
01/24/2008
Last updated
01/24/2008
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