Healthcare Provider Details

I. General information

NPI: 1265052666
Provider Name (Legal Business Name): R&C MEDICAL WIG SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 04/26/2020
Certification Date: 04/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 BRIARWOOD DR STE 400
JACKSON MS
39206-3062
US

IV. Provider business mailing address

460 BRIARWOOD DR STE 400
JACKSON MS
39206-3062
US

V. Phone/Fax

Practice location:
  • Phone: 662-390-7670
  • Fax: 662-262-5850
Mailing address:
  • Phone: 662-390-7670
  • Fax: 662-262-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GEKIYA DAVIS
Title or Position: OWNER
Credential:
Phone: 662-303-7176