Provider Demographics
NPI:1659424174
Name:CAMBRIDGE HEALTHCARE INC.
Entity Type:Organization
Organization Name:CAMBRIDGE HEALTHCARE INC.
Other - Org Name:SLEEP LAB OF WALTERBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-549-2727
Mailing Address - Street 1:PO BOX 1943
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-0020
Mailing Address - Country:US
Mailing Address - Phone:843-549-2727
Mailing Address - Fax:843-549-2707
Practice Address - Street 1:416 ROBERSTON BLVD.
Practice Address - Street 2:SUITE E
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2952
Practice Address - Country:US
Practice Address - Phone:843-549-2727
Practice Address - Fax:843-549-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14779261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0065Medicaid
SCPL0065Medicaid
SCQ328020001Medicare ID - Type UnspecifiedMEDICARE ID #