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Laura C. Randolph Md Sc
Medical Specialty Clinic/Center in Bloomington, Illinois
NPI 1255527727

Laura C. Randolph Md Sc is a Medical Specialty Clinic/Center based in Bloomington, IL and is specialized in Medical Specialty. Laura C. Randolph Md Sc practices in Bloomington, IL. The NPI Number for Laura C. Randolph Md Sc is 1255527727 and holds a License No. 36100030 (Illinois).

The current practice location address for Laura C. Randolph Md Sc is 2502 E Empire St, Bloomington, IL and can be reached out via phone at 309-664-6222 and via fax at 309-664-5006.

Location: 2502 E Empire St, Bloomington, IL, 61704-3738
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1255527727
Provider Name
Laura C. Randolph Md Sc
Credential
Provider Entity Type
Organization
Address
2502 E Empire St, Bloomington, IL, 61704-3738
Phone Number
309-664-6222
Fax Number
309-664-5006
Provider Enumeration Date
09/19/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
097565 01 IL HEALTH ALLIANCE
686867 01 IL HEALTH LINK
P00193845 01 IL RAILROAD MEDICARE
5732066 01 IL BLUE CROSS BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
2502 E Empire St
City
Bloomington
State
Illinois
Zip
61704-3738
Phone Number
309-664-6222
Fax Number
309-664-5006
person
Provider Business Mailing Address Details
Address
2502 E Empire St
City
Bloomington
State
Illinois
Zip
61704-3738
Phone Number
309-664-6222
Fax Number
309-664-5006
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
36100030 (Illinois)
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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