Provider Demographics
NPI:1902805963
Name:RAINBOW MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:RAINBOW MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCRARY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-982-3830
Mailing Address - Street 1:16 186 KALARA ST
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749
Mailing Address - Country:US
Mailing Address - Phone:808-982-3830
Mailing Address - Fax:808-982-3835
Practice Address - Street 1:67-1185 MAMALAHOA HWY STE 33
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7304
Practice Address - Country:US
Practice Address - Phone:808-885-7688
Practice Address - Fax:808-885-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-31163332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C92662OtherHMSA
HI00B92664OtherHMSA
HI0726803Medicaid
HI00B92664OtherHMSA