Provider Demographics
NPI:1629535091
Name:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Entity Type:Organization
Organization Name:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Other - Org Name:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC - PARADISE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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 1:10214 N TATUM BLVD STE B300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4233
Practice Address - Country:US
Practice Address - Phone:480-374-7354
Practice Address - Fax:480-371-1121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-21
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty