MEDICARE: JIMMY RALLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1760317796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY RALLS

Provider Business Mailing Address
First Line	:	PO BOX 189
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73402-0189
Country	:	US
Telephone Number	:	580-319-7305
Fax Number	:	580-319-7328

Provider Business Practice Location Address
First Line	:	2007 N COMMERCE ST
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1268
Country	:	US
Telephone Number	:	580-223-5636
Fax Number	:	580-226-6727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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Directions to “ JIMMY RALLS ” Practice Location

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