Provider Demographics
NPI:1154374296
Name:COMMUNITY NEUROLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:COMMUNITY NEUROLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:804-249-8302
Mailing Address - Street 1:1601 ROLLING HILLS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5011
Mailing Address - Country:US
Mailing Address - Phone:804-249-8302
Mailing Address - Fax:804-249-8321
Practice Address - Street 1:1601 ROLLING HILLS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5011
Practice Address - Country:US
Practice Address - Phone:804-249-8302
Practice Address - Fax:804-249-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
VA0102050193207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007106505Medicaid
VAE25572Medicare UPIN
CJ8741Medicare PIN
VA080006818Medicare PIN
C07006Medicare PIN
VA007106505Medicaid
VA130000803Medicare PIN