Basic Information
| Provider Information | |||||||||
| NPI: | 1306438007 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMPREHENSIVE SURGICAL CARE OF GILBERT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 838 W ELLIOT RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852335162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803747354 | ||||||||
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| Practice Location | |||||||||
| Address1: | 838 W ELLIOT RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852335162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803747354 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2021 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | RAINWATER | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4807704615 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.