Provider Demographics
NPI:1750027371
Name:COMPREHENSIVE SURGICAL CARE OF YUMA, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE SURGICAL CARE OF YUMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-510-2113
Mailing Address - Street 1:PO BOX 200963
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0963
Mailing Address - Country:US
Mailing Address - Phone:520-777-5030
Mailing Address - Fax:520-509-4496
Practice Address - Street 1:2145 W 28TH ST STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-1219
Practice Address - Country:US
Practice Address - Phone:928-877-0526
Practice Address - Fax:928-877-0527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGEN ASC MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-06
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical