Provider Demographics
NPI:1447498449
Name:RAINBOW FAMILY MEDICINE
Entity type:Organization
Organization Name:RAINBOW FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUTANJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-325-3646
Mailing Address - Street 1:1650 SLAUGHTER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8610
Mailing Address - Country:US
Mailing Address - Phone:256-325-3646
Mailing Address - Fax:256-325-3647
Practice Address - Street 1:1650 SLAUGHTER RD
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8610
Practice Address - Country:US
Practice Address - Phone:256-325-3646
Practice Address - Fax:256-325-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center