Basic Information
| Provider Information | |||||||||
| NPI: | 1871223149 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE INTERVENTIONAL CARE CENTERS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 208313 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753208313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207775030 | ||||||||
| FaxNumber: | 5205094496 | ||||||||
| Practice Location | |||||||||
| Address1: | 2145 W 28TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853641219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283288338 | ||||||||
| FaxNumber: | 9283288339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2022 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | FOWELL | ||||||||
| AuthorizedOfficialFirstName: | NICHOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5203226274 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.