Provider Demographics
NPI:1053660795
Name:RAINBOW MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:RAINBOW MEDICAL TRANSPORTATION LLC
Other - Org Name:RAINBOW TRANS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELTAYEB
Authorized Official - Middle Name:AISSA
Authorized Official - Last Name:ABDALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-486-8998
Mailing Address - Street 1:2502 EAST UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034
Mailing Address - Country:US
Mailing Address - Phone:928-524-1086
Mailing Address - Fax:602-207-8387
Practice Address - Street 1:2425 NAVAJO BOULEVARD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025
Practice Address - Country:US
Practice Address - Phone:928-524-1086
Practice Address - Fax:602-207-8387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ702733Medicaid