Provider Demographics
NPI:1770505810
Name:COMPREHENSIVE MANAGEMENT SYSTEMS, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE MANAGEMENT SYSTEMS, INC.
Other - Org Name:COMMUNITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELERUYELLE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:941-748-8922
Mailing Address - Street 1:707 60TH STREET CT E
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-6279
Mailing Address - Country:US
Mailing Address - Phone:941-748-8922
Mailing Address - Fax:
Practice Address - Street 1:707 60TH STREET CT E
Practice Address - Street 2:SUITE D
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-6279
Practice Address - Country:US
Practice Address - Phone:941-748-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103955Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC