Provider Demographics
NPI:1578745170
Name:RAINBOW PEDIATRICS INC.
Entity Type:Organization
Organization Name:RAINBOW PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:RUFFINO
Authorized Official - Last Name:STIFFELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-839-7500
Mailing Address - Street 1:1224 GRAHAM RD
Mailing Address - Street 2:SUITE 3009
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-839-7500
Mailing Address - Fax:314-839-8545
Practice Address - Street 1:1224 GRAHAM RD
Practice Address - Street 2:SUITE 3009
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-839-7500
Practice Address - Fax:314-839-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3N75208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500920905Medicaid