Provider Demographics
NPI:1497038681
Name:RAINBOW HEALTH ACCESS
Entity Type:Organization
Organization Name:RAINBOW HEALTH ACCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-255-4112
Mailing Address - Street 1:PO BOX 13082
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-3082
Mailing Address - Country:US
Mailing Address - Phone:318-255-4112
Mailing Address - Fax:318-255-4174
Practice Address - Street 1:206 E REYNOLDS DR
Practice Address - Street 2:C-3
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2809
Practice Address - Country:US
Practice Address - Phone:318-255-4112
Practice Address - Fax:318-255-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202561208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1343072Medicaid