Provider Demographics
NPI:1700067972
Name:ATLANTIC SLEEP CENTERS, PLLC
Entity Type:Organization
Organization Name:ATLANTIC SLEEP CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-622-4983
Mailing Address - Street 1:7211 OGDEN BUSINESS LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-5300
Mailing Address - Country:US
Mailing Address - Phone:910-371-1777
Mailing Address - Fax:866-302-4209
Practice Address - Street 1:7211 OGDEN BUSINESS LN
Practice Address - Street 2:SUITE 201
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-5300
Practice Address - Country:US
Practice Address - Phone:910-371-1777
Practice Address - Fax:866-302-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94012052084S0012X
NC02123332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335611Medicare PIN