MEDICARE: MR. JASON RALPH RIFFLE C.P.

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	1744P3200X	Prosthetics Case Management	318	TX
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1003065368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON RALPH RIFFLE C.P.

Provider Business Mailing Address
First Line	:	3707 LATROBE DR STE 430
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1361
Country	:	US
Telephone Number	:	704-375-2587
Fax Number	:	704-333-4429

Provider Business Practice Location Address
First Line	:	3707 LATROBE DR STE 430
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1361
Country	:	US
Telephone Number	:	704-375-2587
Fax Number	:	704-333-4429

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	03/07/2023

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