Provider Demographics
NPI:1053464792
Name:SLEEP CENTER OF COLUMBIA
Entity Type:Organization
Organization Name:SLEEP CENTER OF COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-732-2433
Mailing Address - Street 1:1 WELLNESS BLVD
Mailing Address - Street 2:SUITE103
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2871
Mailing Address - Country:US
Mailing Address - Phone:803-732-2433
Mailing Address - Fax:803-732-2624
Practice Address - Street 1:1 WELLNESS BLVD
Practice Address - Street 2:SUITE103
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2871
Practice Address - Country:US
Practice Address - Phone:803-732-2433
Practice Address - Fax:803-732-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1808261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherBCBS IDENTIFIER #