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General NPI Number Information
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NPI Number | 1316195795
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Entity Type | Organization
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Legal Business Name | RIFFLE PROSTHETICS AND ORTHOTICS INC
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 1938 E 70TH ST SUITE D
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City | SHREVEPORT
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State | LA
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Zip | 71105-5340
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Country | US
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Telephone | 318-841-6500
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Fax | 318-841-6501
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Provider Business Mailing Address
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Address Line | 1938 E 70TH ST SUITE D
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City | SHREVEPORT
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State | LA
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Zip | 71105-5340
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Country | US
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Telephone | 318-841-6500
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Fax | 318-841-6501
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON RALPH RIFFLE
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Credential | ABC, CP, BOCP
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Telephone | 318-841-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 30
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 318
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | LA
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