Provider Demographics
NPI:1265507404
Name:SUMMERVILLE SLEEP CONSULTANTS LLC
Entity Type:Organization
Organization Name:SUMMERVILLE SLEEP CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSANNAH
Authorized Official - Middle Name:RAYE
Authorized Official - Last Name:KAELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-871-4006
Mailing Address - Street 1:92 SPRINGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8153
Mailing Address - Country:US
Mailing Address - Phone:843-871-4006
Mailing Address - Fax:843-871-4074
Practice Address - Street 1:92 SPRINGVIEW LN
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8153
Practice Address - Country:US
Practice Address - Phone:843-871-4006
Practice Address - Fax:843-871-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty