Provider Demographics
NPI:1619163953
Name:SLEEP RX
Entity Type:Organization
Organization Name:SLEEP RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-358-0158
Mailing Address - Street 1:9570 TWO NOTCH RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4308
Mailing Address - Country:US
Mailing Address - Phone:803-358-0158
Mailing Address - Fax:803-358-0168
Practice Address - Street 1:454 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6447
Practice Address - Country:US
Practice Address - Phone:803-358-0158
Practice Address - Fax:803-358-0168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLEEP RX INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14529207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ3350010001Medicare PIN