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Organization

RANDOLPH MEDICAL PLUS LLC

Active
Other names
Randolph Mobility and Wellness
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KENTON WILLIAM RANDOLPH ATP (OWNER, ATP)
(816) 364-4357
Entity
Organization

Contact information

Practice address
2303 S 22ND ST, SAINT JOSEPH, MO 64503-2811
(816) 364-4357
(816) 364-3165
Mailing address
PO BOX 1395, SAINT JOSEPH, MO 64502-1395
(816) 364-4357
(816) 364-3165

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
623991205
MO
Enumeration date
08/16/2005
Last updated
12/27/2024
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