Provider Demographics
NPI:1578662094
Name:RANDALL D WOLCOTT MD PA
Entity type:Organization
Organization Name:RANDALL D WOLCOTT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:RASK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-793-8869
Mailing Address - Street 1:2002 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1025
Mailing Address - Country:US
Mailing Address - Phone:806-793-8869
Mailing Address - Fax:806-793-0043
Practice Address - Street 1:2002 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1025
Practice Address - Country:US
Practice Address - Phone:806-793-8869
Practice Address - Fax:806-793-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6248208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB9128OtherRAILROAD MEDICARE
NMW7688Medicaid
DB9128OtherRAILROAD MEDICARE
NMW7688Medicaid