Provider Demographics
NPI:1972933794
Name:RANDOLPH A KNIGHT MD LLC
Entity type:Organization
Organization Name:RANDOLPH A KNIGHT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-782-5543
Mailing Address - Street 1:38022 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1383
Mailing Address - Country:US
Mailing Address - Phone:813-782-5543
Mailing Address - Fax:813-788-9342
Practice Address - Street 1:38022 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1383
Practice Address - Country:US
Practice Address - Phone:813-782-5543
Practice Address - Fax:813-788-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010340700Medicaid
FL7151750001OtherDME
FL010340700Medicaid