Provider Demographics
NPI:1255654877
Name:ATLANTIC SLEEP DISORDERS CENTER LLC
Entity Type:Organization
Organization Name:ATLANTIC SLEEP DISORDERS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-235-9831
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-1250
Mailing Address - Country:US
Mailing Address - Phone:843-235-9831
Mailing Address - Fax:843-235-9853
Practice Address - Street 1:9657 S OCEAN HWY 17
Practice Address - Street 2:STE 4B
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7425
Practice Address - Country:US
Practice Address - Phone:843-235-9831
Practice Address - Fax:843-235-9853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3431293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0096Medicaid
SCQ356150001Medicare PIN