Provider Demographics
NPI:1659320992
Name:CLINICAL NEUROLOGICAL SPECIALTIES, INC.
Entity Type:Organization
Organization Name:CLINICAL NEUROLOGICAL SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-443-3295
Mailing Address - Street 1:430 MORTON PLANT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3398
Mailing Address - Country:US
Mailing Address - Phone:727-443-3295
Mailing Address - Fax:727-446-4336
Practice Address - Street 1:430 MORTON PLANT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3398
Practice Address - Country:US
Practice Address - Phone:727-443-3295
Practice Address - Fax:727-446-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00125032084N0400X
FLME00293482084N0400X
FLME00434852084N0400X
FLME743172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57338Medicare UPIN
FL62190ZMedicare ID - Type UnspecifiedROBERT VOLLBRACHT
FL01814Medicare ID - Type UnspecifiedAJAY ARORA
FLD58202Medicare UPIN
FLD57511Medicare UPIN
FL62605ZMedicare ID - Type UnspecifiedDIANA POLLOCK
FLD52337Medicare UPIN
FL71818XMedicare ID - Type UnspecifiedMICHAEL ANDRIOLA