MEDICARE: PALMETTO SLEEP & DIAGNOSTIC, LLC

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
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1659353373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO SLEEP & DIAGNOSTIC, LLC

Provider Business Mailing Address
First Line	:	527 MILLS AVE
Second Line	:	SUITE 101-B
City	:	GREENVILLE
State	:	SC
Zip	:	29605-5602
Country	:	US
Telephone Number	:	864-242-8884
Fax Number	:	864-242-2585

Provider Business Practice Location Address
First Line	:	9657 OCEAN HWY
Second Line	:	SUITE 4-B
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-7425
Country	:	US
Telephone Number	:	843-235-9831
Fax Number	:	864-235-9853

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. CYNTHIA A BARNES
Credential	:
Telephone Number	:	864-242-8884

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	08/22/2020

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