Provider Demographics
NPI:1568414555
Name:COMPREHENSIVE NEUROLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:COMPREHENSIVE NEUROLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-669-2007
Mailing Address - Street 1:PO BOX 7124
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-7124
Mailing Address - Country:US
Mailing Address - Phone:843-669-2007
Mailing Address - Fax:843-669-6677
Practice Address - Street 1:436 W PALMETTO STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-669-2007
Practice Address - Fax:843-669-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC182762084N0400X
SC229022084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0503617OtherCCP
SCT22981Medicaid
SCT71749Medicaid
SCGP3382Medicaid
H54206Medicare UPIN
E99320Medicare UPIN