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General NPI Number Information
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NPI Number | 1194282400
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 6958 SW VARNS ST
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City | PORTLAND
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State | OR
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Zip | 97223-0000
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Country | US
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Telephone | 503-683-7730
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Fax | 503-914-0927
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Provider Business Mailing Address
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Address Line | 4001 E BASELINE RD STE 107
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City | GILBERT
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State | AZ
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Zip | 85234-2744
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Country | US
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Telephone | 480-374-7354
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Fax | 480-371-1121
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL R. RAINWATER
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Credential | MD
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Telephone | 480-374-7354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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