1053660795 NPI number — RAINBOW MEDICAL TRANSPORTATION LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053660795 NPI number — RAINBOW MEDICAL TRANSPORTATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAINBOW MEDICAL TRANSPORTATION LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053660795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2502 EAST UNIVERSITY DRIVE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-524-1086
Provider Business Mailing Address Fax Number:
602-207-8387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 NAVAJO BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLBROOK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-524-1086
Provider Business Practice Location Address Fax Number:
602-207-8387
Provider Enumeration Date:
09/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ABDALLA
Authorized Official First Name:
ELTAYEB
Authorized Official Middle Name:
AISSA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
602-486-8998

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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