MEDICARE: J RAPHA MEDICAL GROUP

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	335E00000X	Prosthetic/Orthotic Supplier	C16081	MS

General Provider Information

NPI Number	:	1588845523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J RAPHA MEDICAL GROUP

Provider Business Mailing Address
First Line	:	P. O. BOX 948
Second Line	:
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-2938
Country	:	US
Telephone Number	:	662-746-4700
Fax Number	:	662-746-0022

Provider Business Practice Location Address
First Line	:	1010 CALHOUN AVE
Second Line	:
City	:	YAZOO CITY
State	:	MS
Zip	:	39194-2938
Country	:	US
Telephone Number	:	662-746-4700
Fax Number	:	662-746-0022

Authorized Official
Title or Position	:	CERTIFIED PROSTHETIST
Name	:	MRS. ROBBIN ALEXANDER WRIGHT
Credential	:	BOCP
Telephone Number	:	662-746-4700

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/20/2007

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