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General NPI Number Information
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NPI Number | 1174523286
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Entity Type | Organization
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Legal Business Name | SOUTH CAROLINA SLEEP MEDICINE LLC
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 92 SPRINGVIEW LN
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8153
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Country | US
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Telephone | 843-871-4006
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Fax | 843-871-4074
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Provider Business Mailing Address
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Address Line | 92 SPRINGVIEW LN
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8153
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Country | US
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Telephone | 843-871-4006
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Fax | 843-871-4074
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Authorized Official
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Title or Position | MANAGER
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Name | SUSANNAH RAYE KAELIN
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Credential |
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Telephone | 843-871-4006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State | SC
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