Healthcare Provider Details

I. General information

NPI: 1881197523
Provider Name (Legal Business Name): COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/03/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 W ELLIOT RD STE 101
GILBERT AZ
85233-5162
US

IV. Provider business mailing address

838 W ELLIOT RD STE 101
GILBERT AZ
85233-5162
US

V. Phone/Fax

Practice location:
  • Phone: 480-374-7354
  • Fax:
Mailing address:
  • Phone: 480-374-7354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOEL R. RAINWATER
Title or Position: PRESIDENT
Credential: MD
Phone: 480-374-7354