Healthcare Provider Details

I. General information

NPI: 1003439712
Provider Name (Legal Business Name): COMPREHENSIVE SURGICAL CARE OF SUN CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14642 N DEL WEBB BLVD STE 100
SUN CITY AZ
85351-2101
US

IV. Provider business mailing address

14642 N DEL WEBB BLVD STE 100
SUN CITY AZ
85351-2101
US

V. Phone/Fax

Practice location:
  • Phone: 888-888-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL RAINWATER
Title or Position: CEO
Credential: MD
Phone: 214-695-4765