1386087138 NPI number — RAINBOW OMEGA, INC.

Table of content: MR. ALVA BURTON PAYNE M.D. (NPI 1447570866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386087138 NPI number — RAINBOW OMEGA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAINBOW OMEGA, INC.
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:
1386087138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 740
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTABOGA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36260-0740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-831-0919
Provider Business Mailing Address Fax Number:
256-831-0942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HORIZON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTABOGA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36260-7310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-831-0919
Provider Business Practice Location Address Fax Number:
256-831-0942
Provider Enumeration Date:
04/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CARPENTER
Authorized Official First Name:
MALCOM
Authorized Official Middle Name:
STENTSON
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
256-831-0919

Provider Taxonomy Codes

  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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