Organization
RAINBOW MEDICAL CLINIC
Active
Other names
Stephen Shortridge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN MATTHEW SHORTRIGE PA-C (OWNER)
(907) 892-3350
Entity
Organization
Contact information
Practice address
10927 WEST PARKS HWY., BIG LAKE, AK 99652-0562
(907) 892-3350
(907) 892-3351
Mailing address
PO BOX 520562, BIG LAKE, AK 99652-0562
(907) 892-3350
(907) 892-3351
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
394
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700994118
NPI
—
Enumeration date
12/09/2008
Last updated
07/23/2009
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