Provider Demographics
NPI:1992063945
Name:RANDALL INC.
Entity type:Organization
Organization Name:RANDALL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DREESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-775-3544
Mailing Address - Street 1:19721 SCRIBER LAKE RD STE D
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6119
Mailing Address - Country:US
Mailing Address - Phone:425-775-3544
Mailing Address - Fax:425-670-6502
Practice Address - Street 1:19721 SCRIBER LAKE RD
Practice Address - Street 2:#D
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-775-3544
Practice Address - Fax:425-670-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2221305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001201047Medicare UPIN