Provider Demographics
NPI:1629105374
Name:COMPREHENSIVE NEUROSURGICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE NEUROSURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-471-3676
Mailing Address - Street 1:801 ST MARY'S DRIVE
Mailing Address - Street 2:SUITE 505 EAST
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-471-3676
Mailing Address - Fax:812-469-4124
Practice Address - Street 1:801 ST MARY'S DRIVE
Practice Address - Street 2:SUITE 505 EAST
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714
Practice Address - Country:US
Practice Address - Phone:812-471-3676
Practice Address - Fax:812-469-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty