Provider Demographics
NPI:1952355026
Name:RAINBOLT, CHARLES DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DANIEL
Last Name:RAINBOLT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL CIR STE 204
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4597
Practice Address - Country:US
Practice Address - Phone:731-641-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2671207P00000X
TNDO0000001442207P00000X
TN1442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64013097Medicaid
KY0944505Medicare ID - Type Unspecified
KY64013097Medicaid