Provider Demographics
NPI:1215182464
Name:RAPHA MEDICAL CENTER, PLLC
Entity Type:Organization
Organization Name:RAPHA MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TARKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-263-4716
Mailing Address - Street 1:222 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-2011
Mailing Address - Country:US
Mailing Address - Phone:704-263-4716
Mailing Address - Fax:704-263-8169
Practice Address - Street 1:222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2011
Practice Address - Country:US
Practice Address - Phone:704-263-4716
Practice Address - Fax:704-263-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28091173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2013091CMedicare PIN