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General NPI Number Information
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NPI Number | 1205234259
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Entity Type | Organization
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Legal Business Name | CLAIRE BROOKE SLEEP CENTER LLC
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 102 GREENLAND DR
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City | GOOSE CREEK
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State | SC
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Zip | 29445-5353
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Country | US
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Telephone | 843-203-6551
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Fax | 843-203-6552
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Provider Business Mailing Address
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Address Line | 102 GREENLAND DR
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City | GOOSE CREEK
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State | SC
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Zip | 29445-5353
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Country | US
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Telephone | 843-203-6551
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Fax | 843-203-6552
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Authorized Official
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Title or Position | OWNER
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Name | MISS KIMBERLY DAWN KOGER
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Credential | RRT, RPSGT
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Telephone | 843-203-6551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State | SC
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