Provider Demographics
NPI:1952340390
Name:CAROLINA SLEEP DIAGNOSTICS, INC
Entity type:Organization
Organization Name:CAROLINA SLEEP DIAGNOSTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:843-841-1220
Mailing Address - Street 1:200 W HARRISON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3310
Mailing Address - Country:US
Mailing Address - Phone:843-841-1220
Mailing Address - Fax:843-841-2062
Practice Address - Street 1:2724 W PALMETTO ST
Practice Address - Street 2:SUITE 12
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4909
Practice Address - Country:US
Practice Address - Phone:843-678-8998
Practice Address - Fax:843-678-8999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA SLEEP DIAGNOSTICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0077Medicaid
SCPENDINGMedicare ID - Type UnspecifiedPROVIDER NUMBER
SCPL0077Medicaid