Provider Demographics
NPI:1124201629
Name:RANDY L SMITH DBA C&R MEDICAL
Entity type:Organization
Organization Name:RANDY L SMITH DBA C&R MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-590-8166
Mailing Address - Street 1:2908 SE LOOP 820
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1019
Mailing Address - Country:US
Mailing Address - Phone:817-590-8166
Mailing Address - Fax:817-590-8277
Practice Address - Street 1:2908 SE LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-1019
Practice Address - Country:US
Practice Address - Phone:817-590-8166
Practice Address - Fax:817-590-8277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANDY L SMITH DBA C&R MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-07
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187200402Medicaid
TX187200401Medicaid
5834680001Medicare NSC