Provider Demographics
NPI:1316195795
Name:RIFFLE PROSTHETICS AND ORTHOTICS INC
Entity Type:Organization
Organization Name:RIFFLE PROSTHETICS AND ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:RIFFLE
Authorized Official - Suffix:
Authorized Official - Credentials:ABC, CP, BOCP
Authorized Official - Phone:318-841-6500
Mailing Address - Street 1:1938 E 70TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5340
Mailing Address - Country:US
Mailing Address - Phone:318-841-6500
Mailing Address - Fax:318-841-6501
Practice Address - Street 1:1938 E 70TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5340
Practice Address - Country:US
Practice Address - Phone:318-841-6500
Practice Address - Fax:318-841-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA335E00000X
OK30335E00000X
TX318335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1995235OtherMEDICAID - TEXAS
LA6139950001Medicare NSC