Provider Demographics
NPI:1710935523
Name:COASTAL SLEEP LAB, INC
Entity Type:Organization
Organization Name:COASTAL SLEEP LAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-445-9700
Mailing Address - Street 1:4420 OLEANDER DR
Mailing Address - Street 2:STE 105
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5720
Mailing Address - Country:US
Mailing Address - Phone:843-445-9700
Mailing Address - Fax:843-946-9460
Practice Address - Street 1:4420 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5720
Practice Address - Country:US
Practice Address - Phone:843-445-9700
Practice Address - Fax:843-946-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0082Medicaid
SCPL0082Medicaid