Healthcare Provider Details

I. General information

NPI: 1942913736
Provider Name (Legal Business Name): COMPREHENSIVE SURGICAL CARE OF ALBUQUERQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 JEFFERSON ST NE STE 100
ALBUQUERQUE NM
87109-2130
US

IV. Provider business mailing address

8475 E HARTFORD DR STE 201
SCOTTSDALE AZ
85255-5477
US

V. Phone/Fax

Practice location:
  • Phone: 505-932-7112
  • 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: 480-219-0123