MEDICARE: COMPREHENSIVE SURGICAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1760968234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE SURGICAL CARE LLC

Provider Business Mailing Address
First Line	:	4001 E BASELINE RD STE 107
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2744
Country	:	US
Telephone Number	:	480-374-7354
Fax Number	:	480-371-1121

Provider Business Practice Location Address
First Line	:	14642 N DEL WEBB BLVD
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2147
Country	:	US
Telephone Number	:	480-374-7354
Fax Number	:	480-371-1121

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOEL R RAINWATER
Credential	:	MD
Telephone Number	:	480-374-7354

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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