Healthcare Provider Details

I. General information

NPI: 1497857742
Provider Name (Legal Business Name): PULMONARY CRITICAL CARE & SLEEP ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 OMNI DRIVE SUITE A
SENECA SC
29672
US

IV. Provider business mailing address

107 OMNI DRIVE SUITE A
SENECA SC
29672
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN RAWL
Title or Position: MANAGER
Credential:
Phone: 803-358-6762