| Organization Name: | RANDY'S HOUSE OF MEDICINE |
| NPI Number: | 1780714386 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE WYATT (OWNER) |
| Mailing Address: | 305 Front St Taylorsville |
| State: | MS US |
| Postal Code: | 39168 |
| Phone Number: | 6017856812 |
| Fax Number: | 6017854993 |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 01523011 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |