Provider Demographics
NPI:1568965697
Name:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Other - Org Name:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC - UTAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-322-6274
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:
Practice Address - Street 1:5343 S WOODROW ST STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5885
Practice Address - Country:US
Practice Address - Phone:801-810-2999
Practice Address - Fax:801-396-9157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-15
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty