Provider Demographics
NPI:1588845523
Name:J RAPHA MEDICAL GROUP
Entity Type:Organization
Organization Name:J RAPHA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBBIN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:BOCP
Authorized Official - Phone:662-746-4700
Mailing Address - Street 1:P. O. BOX 948
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-2938
Mailing Address - Country:US
Mailing Address - Phone:662-746-4700
Mailing Address - Fax:662-746-0022
Practice Address - Street 1:1010 CALHOUN AVE
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2938
Practice Address - Country:US
Practice Address - Phone:662-746-4700
Practice Address - Fax:662-746-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC16081335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4269660001Medicare NSC