Healthcare Provider Details

I. General information

NPI: 1942273354
Provider Name (Legal Business Name): CAROLINA SLEEP MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N FAYETTEVILLE ST SUITE 102
ASHEBORO NC
27203-4670
US

IV. Provider business mailing address

495 ARBOR HILL ROAD SUITE G
KERNERSVILLE NC
27284
US

V. Phone/Fax

Practice location:
  • Phone: 336-993-8448
  • Fax: 336-993-8488
Mailing address:
  • Phone: 336-993-8448
  • Fax: 336-993-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number001136390
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFF RAGAN
Title or Position: PRESIDENT AND C.E.O.
Credential:
Phone: 336-993-8448