Provider Demographics
NPI:1922779578
Name:RAINBOW PEDIATRICS PC LLC BEACH
Entity Type:Organization
Organization Name:RAINBOW PEDIATRICS PC LLC BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-248-2468
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-0578
Mailing Address - Country:US
Mailing Address - Phone:850-249-3500
Mailing Address - Fax:850-249-3530
Practice Address - Street 1:10800 PANAMA CITY BEACH PKWY STE 400
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2532
Practice Address - Country:US
Practice Address - Phone:850-249-3500
Practice Address - Fax:850-249-3530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAINBOW PEDIATRICS PC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty