Provider Demographics
NPI:1215132253
Name:RAINBOW PEDIATRIC CLINIC
Entity type:Organization
Organization Name:RAINBOW PEDIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-464-8231
Mailing Address - Street 1:5507 WALSH LN STE 101
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9007
Mailing Address - Country:US
Mailing Address - Phone:479-464-8231
Mailing Address - Fax:479-464-8230
Practice Address - Street 1:5507 WALSH LN STE 101
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9007
Practice Address - Country:US
Practice Address - Phone:479-464-8231
Practice Address - Fax:479-464-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG87228Medicare UPIN