Provider Demographics
NPI:1548856164
Name:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CMO
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAINWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-374-7354
Mailing Address - Street 1:4001 E BASELINE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2744
Mailing Address - Country:US
Mailing Address - Phone:480-374-7354
Mailing Address - Fax:480-371-1121
Practice Address - Street 1:130 S 63RD ST STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1620
Practice Address - Country:US
Practice Address - Phone:480-985-6000
Practice Address - Fax:480-985-8641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty