Active NPI
Quinten Randolph
- Vehicle Modifications Contractor
- Saint Louis, MO
National Provider Identifier
1235584525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vehicle Modifications Contractor
- License
- LC001476161
- Practice address
- 206 Emerling Dr
Saint Louis, MO 63121-1022 - Phone
- (314) 566-7109
- NPI assigned
- Apr 25, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vehicle Modifications Contractor | 171WV0202X | LC001476161 | MO | Primary |
Addresses
Primary practice location
206 Emerling Dr
Saint Louis, MO 63121-1022
Mailing address
206 Emerling Dr
Saint Louis, MO 63121-1022
Phone (314) 566-7109
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC001476161 | MO | MD | Vehicle Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461542400000",
"number": "1235584525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 EMERLING DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631211022",
"telephone_number": "314-566-7109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 EMERLING DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631211022",
"telephone_number": "314-566-7109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "QUINTEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-25",
"last_updated": "2016-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "171WV0202X",
"taxonomy_group": "",
"desc": "Contractor, Vehicle Modifications",
"state": "MO",
"license": "LC001476161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.