MEDICARE: COMPREHENSIVE NEUROLOGICS & SLEEP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	13877R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154354264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE NEUROLOGICS & SLEEP

Provider Business Mailing Address
First Line	:	224 SAINT LANDRY ST STE 2B
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-3549
Country	:	US
Telephone Number	:	337-235-4554
Fax Number	:	337-235-4556

Provider Business Practice Location Address
First Line	:	224 SAINT LANDRY ST STE 2B
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-3549
Country	:	US
Telephone Number	:	337-235-4554
Fax Number	:	337-235-4556

Authorized Official
Title or Position	:	OFFICER
Name	:	KEVIN RENEE HARGRAVE
Credential	:
Telephone Number	:	337-235-4556

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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Directions to “COMPREHENSIVE NEUROLOGICS & SLEEP ” Practice Location

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