Healthcare Provider Details

I. General information

NPI: 1629535091
Provider Name (Legal Business Name): COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10214 N TATUM BLVD STE B300
PHOENIX AZ
85028-4233
US

IV. Provider business mailing address

4001 E BASELINE RD STE 107
GILBERT AZ
85234-2744
US

V. Phone/Fax

Practice location:
  • Phone: 480-374-7354
  • Fax: 480-371-1121
Mailing address:
  • Phone: 480-374-7354
  • Fax: 480-371-1121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

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