Provider Demographics
NPI:1912169368
Name:WILLIAM G RAINER JR PC
Entity Type:Organization
Organization Name:WILLIAM G RAINER JR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAINER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:970-565-4500
Mailing Address - Street 1:106 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3749
Mailing Address - Country:US
Mailing Address - Phone:970-565-4500
Mailing Address - Fax:970-565-0862
Practice Address - Street 1:106 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3749
Practice Address - Country:US
Practice Address - Phone:970-565-4500
Practice Address - Fax:970-565-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28307174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27935221Medicaid
CO27935221Medicaid