Provider Demographics
NPI:1508272493
Name:JC RAPHA MEDICAL MANAGEMENT GROUP
Entity Type:Organization
Organization Name:JC RAPHA MEDICAL MANAGEMENT GROUP
Other - Org Name:REDBIRD MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-330-0002
Mailing Address - Street 1:3107 W CAMP WISDOM RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2643
Mailing Address - Country:US
Mailing Address - Phone:214-330-0002
Mailing Address - Fax:214-330-0010
Practice Address - Street 1:3107 W CAMP WISDOM RD
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2643
Practice Address - Country:US
Practice Address - Phone:214-330-0002
Practice Address - Fax:214-330-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty