Healthcare Provider Details

I. General information

NPI: 1114939089
Provider Name (Legal Business Name): PSC SLEEP CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WOODRUFF RD SUITE 450
GREENVILLE SC
29607-3495
US

IV. Provider business mailing address

430 WOODRUFF RD SUITE 450
GREENVILLE SC
29607-3495
US

V. Phone/Fax

Practice location:
  • Phone: 864-527-5970
  • Fax: 864-527-5971
Mailing address:
  • Phone: 864-527-5970
  • Fax: 864-527-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW S. MELLOTT
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 864-527-5970