Provider Demographics
NPI:1750462701
Name:LIBERTY SLEEP ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LIBERTY SLEEP ASSOCIATES, LLC
Other - Org Name:LIBERTY SLEEP ASSOCIATES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:D
Authorized Official - Last Name:DURRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MD
Authorized Official - Phone:843-795-5362
Mailing Address - Street 1:418 FOLLY RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2625
Mailing Address - Country:US
Mailing Address - Phone:843-795-5553
Mailing Address - Fax:843-795-2262
Practice Address - Street 1:418 FOLLY RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2625
Practice Address - Country:US
Practice Address - Phone:843-795-5553
Practice Address - Fax:843-795-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty