RANDOM LAKE SPINE & SPORTS CLINIC
NPI 1659543205
Clinic/Center in Random Lake, WI

Q: What is Random Lake Spine & Sports Clinic's NPI number?

The NPI number for Random Lake Spine & Sports Clinic is 1659543205. It was assigned to this organization in the NPPES registry on March 24, 2008.

Q: What is Random Lake Spine & Sports Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since March 24, 2008

321 CARROLL ST., RANDOM LAKE, WI 53075(920) 994-2000 Get Directions Write a Review

NPPES record last updated: June 2, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Random Lake Spine & Sports Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RANDOM LAKE SPINE & SPORTS CLINIC (NPI 1659543205) is a healthcare organization registered as a clinic/center in Random Lake, Wisconsin and active in the NPI registry since March 2008. The organization lists Jason C Rudelich, President, as its authorized official.

NPPES Registry Identity

NPI1659543205

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NameRANDOM LAKE SPINE & SPORTS CLINIC

Location Address321 CARROLL ST.Random Lake, WI 53075

Mailing AddressPo Box 196Random Lake, WI 53075-0196 · (920) 994-2000

Phone(920) 994-2000

Organization SubpartNo

Authorized OfficialJason C RudelichPresident · (920) 994-2000

Enumeration DateMarch 24, 2008

Last NPPES UpdateJune 2, 2008

✔ NPI 1659543205 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

321 CARROLL ST., Random Lake, WI 53075

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Random Lake Spine & Sports Clinic's NPI number?

The NPI number for Random Lake Spine & Sports Clinic is 1659543205. It was assigned to this organization in the NPPES registry on March 24, 2008.

Where is Random Lake Spine & Sports Clinic located?

Random Lake Spine & Sports Clinic is located at 321 Carroll St., Random Lake, WI 53075. The listed phone number is (920) 994-2000.

What is Random Lake Spine & Sports Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Random Lake Spine & Sports Clinic was last updated on June 2, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.