Active NPI
Randall Dean Wilcox, LAB DIRECTOR
- Phlebotomy Technician
- Las Cruces, NM
National Provider Identifier
1144592304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebotomy Technician
- Practice address
- 383 Fossil View Rd
Las Cruces, NM 88007 - Phone
- (575) 520-3254
- NPI assigned
- Feb 3, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | |||
| Home Health Agency | 251E00000X | |||
| Clinical Medical Laboratory | 291U00000X | |||
| Adult Care Home Facility | 311ZA0620X | |||
| Private Vehicle | 347C00000X | |||
| Phlebotomy Technician | 246RP1900X | NM | Primary |
Addresses
Primary practice location
383 Fossil View Rd
Las Cruces, NM 88007
Mailing address
PO Box 155
Radium Springs, NM 88054-0155
Phone (575) 520-3254
Other practice location 1
383 Fossil View Rd
Las Cruces, NM 88007-7176
Phone (575) 520-3254
Other practice location 2
383 Fossil View Rd
Las Cruces, NM 88007
Phone (575) 520-3254
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 291U00000X | Medicaid | NM | |
| 347C00000X | Medicaid | NM | |
| 311ZA0620X | Medicaid | NM | |
| 251E00000X | Medicaid | NM | |
| 1144592304 | Medicaid | NM | |
| 246RP19000X-PHEBOTOM | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Mobile Lab LLC | Home Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552608000000",
"number": "1144592304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 155",
"city": "RADIUM SPRINGS",
"state": "NM",
"postal_code": "880540155",
"telephone_number": "575-520-3254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "383 FOSSIL VIEW RD",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "88007",
"telephone_number": "575-520-3254"
}
],
"practiceLocations": [
{
"address_1": "383 Fossil View Rd",
"address_purpose": "LOCATION",
"city": "Las Cruces",
"state": "NM",
"postal_code": "880077176",
"country_code": "US",
"telephone_number": "575-520-3254",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "383 Fossil View Rd",
"address_purpose": "LOCATION",
"city": "Las Cruces",
"state": "NM",
"postal_code": "88007",
"country_code": "US",
"telephone_number": "575-520-3254",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILCOX",
"first_name": "RANDALL",
"middle_name": "DEAN",
"credential": "LAB DIRECTOR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-03",
"last_updated": "2019-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": false
},
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": false
},
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": null,
"license": null,
"primary": false
},
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": null,
"license": null,
"primary": false
},
{
"code": "246RP1900X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Phlebotomy",
"state": "NM",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "291U00000X",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "347C00000X",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "311ZA0620X",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "251E00000X",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1144592304",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "246RP19000X-PHEBOTOM",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.