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NPI Code Detail

MEDICARE: SOUTH CAROLINA ENT ALLERGY & SLEEP MEDICINE PA

MEDICARE: SOUTH CAROLINA ENT ALLERGY & SLEEP MEDICINE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207YP0228XPediatric Otolaryngology Physician
2207YS0012XSleep Medicine (Otolaryngology) Physician
3225100000XPhysical Therapist
4235Z00000XSpeech-Language Pathologist
5207Y00000XOtolaryngology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DE5192OTHERSCUNSPECIFIED
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134153083
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH CAROLINA ENT ALLERGY & SLEEP MEDICINE PA
Provider Business Mailing Address
First Line : PO BOX 520
Second Line :
City : LUGOFF
State : SC
Zip : 29078-0520
Country : US
Telephone Number : 803-408-3277
Fax Number : 803-408-3277
Provider Business Practice Location Address
First Line : 15 EXCHANGE DR
Second Line :
City : LUGOFF
State : SC
Zip : 29078-9198
Country : US
Telephone Number : 803-408-3277
Fax Number : 803-408-3277
Authorized Official
Title or Position : CHIEF REVENUE OFFICER
Name : PAMELA LEA KIRBY
Credential :
Telephone Number : 803-424-2207
Provider Enumeration Date : 07/10/2006
Last Update Date : 05/26/2020

Similar Medicare Providers

1861499618 — ROBERT KABAKJIAN SR. P.A.-C
Practice Location Address:
15 EXCHANGE DR
LUGOFF, SC
29078-9198
Practice Phone: 803-408-3277
Practice Fax: 803-408-3277
1447293121 — DR. DAVID MACY VIDRINE M.D.
Practice Location Address:
15 EXCHANGE DR
LUGOFF, SC
29078-9198
Practice Phone: 803-408-3277
Practice Fax: 803-408-3282
1740215904 — DR. ROBERT PUCHALSKI M.D.
Practice Location Address:
15 EXCHANGE DR
LUGOFF, SC
29078-9198
Practice Phone: 803-408-3277
Practice Fax: 803-408-3299
1932115409 — THERIN SCOTT HILL PA-C
Practice Location Address:
15 EXCHANGE DR
LUGOFF, SC
29078-9198
Practice Phone: 803-408-3277
Practice Fax:
1154339695 — STEPHANIE H TETTERTON PA
Practice Location Address:
15 EXCHANGE DR
LUGOFF, SC
29078-9198
Practice Phone: 803-408-3277
Practice Fax: 803-408-3282
1457438905 — DR. KELLY ANN LONG AU.D.
Practice Location Address:
15 EXCHANGE DR
LUGOFF, SC
29078-9198
Practice Phone: 803-408-3277
Practice Fax: 803-408-3299

Directions to “SOUTH CAROLINA ENT ALLERGY & SLEEP MEDICINE PA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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