Provider Demographics
NPI:1699718213
Name:COMPREHENSIVE MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:COMPREHENSIVE MEDICAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:WIESNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-797-5700
Mailing Address - Street 1:8410 RIVERS AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9271
Mailing Address - Country:US
Mailing Address - Phone:843-797-5700
Mailing Address - Fax:843-824-9005
Practice Address - Street 1:3951 WEST ASHLEY CIRCLE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-766-9771
Practice Address - Fax:843-766-9773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE MEDICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2845Medicaid
SC0673480004Medicare NSC