Healthcare Provider Details

I. General information

NPI: 1053329003
Provider Name (Legal Business Name): CINDY RAGLAND IRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHURCH ST
BELZONI MS
39038-3929
US

IV. Provider business mailing address

111 CHURCH ST P O BOX 327
BELZONI MS
39038-3929
US

V. Phone/Fax

Practice location:
  • Phone: 662-247-1103
  • Fax: 662-247-1103
Mailing address:
  • Phone: 662-247-1103
  • Fax: 662-247-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: CINDY RAGLAND
Title or Position: OWNER
Credential:
Phone: 662-247-2655