Provider Demographics
NPI:1619073798
Name:CAROLINA SLEEP MEDICINE
Entity Type:Organization
Organization Name:CAROLINA SLEEP MEDICINE
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:877-665-3672
Mailing Address - Street 1:175 AMENDMENT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 AMENDMENT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3039
Practice Address - Country:US
Practice Address - Phone:803-327-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic