MEDICARE: COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1881197523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC

Provider Business Mailing Address
First Line	:	838 W ELLIOT RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5162
Country	:	US
Telephone Number	:	480-374-7354
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 W ELLIOT RD STE 101
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85233-5162
Country	:	US
Telephone Number	:	480-374-7354
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOEL R. RAINWATER
Credential	:	MD
Telephone Number	:	480-374-7354

Provider Enumeration Date	:	03/08/2018
Last Update Date	:	03/03/2021

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