=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154374296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY NEUROLOGICAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 08/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 ROLLING HILLS DR SUITE 200
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-5011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-249-8302
-----------------------------------------------------
Fax | 804-249-8321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 ROLLING HILLS DR SUITE 200
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-5011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-249-8302
-----------------------------------------------------
Fax | 804-249-8321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | VERONICA CUNNINGHAM
-----------------------------------------------------
Credential | R.N., B.S.N.
-----------------------------------------------------
Telephone | 804-249-8302
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | 0102050193
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------