Provider Demographics
NPI:1730246034
Name:RAINBOW MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:RAINBOW MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:TRAUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-770-4955
Mailing Address - Street 1:402 MARYLAND AVE # C
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3438
Mailing Address - Country:US
Mailing Address - Phone:410-770-4955
Mailing Address - Fax:
Practice Address - Street 1:402 MARYLAND AVE # C
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3438
Practice Address - Country:US
Practice Address - Phone:410-770-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2285332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5685830001Medicare ID - Type Unspecified