Provider Demographics
NPI:1598903528
Name:CAROLINA PULMONARY & SLEEP DISORDER, LLC
Entity Type:Organization
Organization Name:CAROLINA PULMONARY & SLEEP DISORDER, LLC
Other - Org Name:ABBAS MANSOUR 'DBA' CAROLINA PULMONARY & SLEEP DISORDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-850-0700
Mailing Address - Street 1:68 GLOBAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4628
Mailing Address - Country:US
Mailing Address - Phone:864-644-2700
Mailing Address - Fax:864-644-2709
Practice Address - Street 1:109 FLEETWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2019
Practice Address - Country:US
Practice Address - Phone:864-850-0700
Practice Address - Fax:864-850-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26847207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC268472Medicaid