Provider Demographics
NPI:1497857742
Name:PULMONARY CRITICAL CARE & SLEEP ASSOCIATES PA
Entity Type:Organization
Organization Name:PULMONARY CRITICAL CARE & SLEEP ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-358-6762
Mailing Address - Street 1:107 OMNI DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 OMNI DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672
Practice Address - Country:US
Practice Address - Phone:864-482-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7406Medicare PIN