Randall Kenneth Cantrell, GENERAL CONTRACTOR

Primary specialty

Home Modifications ContractorTaxonomy code 171WH0202X

License

2705030223 Issued in VA

Practice address

8902 Orby Cantrell Hwy
Pound, VA 24279-3216

Phone

(276) 796-5789

Fax

(276) 796-5789

NPI assigned

Feb 1, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1689712010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8902 ORBY CANTRELL HWY",
            "city": "POUND",
            "state": "VA",
            "postal_code": "242793216",
            "telephone_number": "276-796-5789",
            "fax_number": "276-796-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8902 ORBY CANTRELL HWY",
            "city": "POUND",
            "state": "VA",
            "postal_code": "242793216",
            "telephone_number": "276-796-5789",
            "fax_number": "276-796-5789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTRELL",
        "first_name": "RANDALL",
        "middle_name": "KENNETH",
        "name_prefix": "Mr.",
        "credential": "GENERAL CONTRACTOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171WH0202X",
            "taxonomy_group": "",
            "desc": "Contractor, Home Modifications",
            "state": "VA",
            "license": "2705030223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010277388",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zachary Ryan Bush, PHARMD
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• Experienced Care Clinic Inc.
• Family Preservation Services, Inc

• Home Modifications Contractor in Pound, VA
• Providers in Pound, VA by specialty
• Home Modifications Contractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.