MEDICARE: CAROLINA SLEEP DIAGNOSTICS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952340390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA SLEEP DIAGNOSTICS, INC

Provider Business Mailing Address
First Line	:	200 W HARRISON ST
Second Line	:	SUITE B
City	:	DILLON
State	:	SC
Zip	:	29536-3310
Country	:	US
Telephone Number	:	843-841-1220
Fax Number	:	843-841-2062

Provider Business Practice Location Address
First Line	:	2724 W PALMETTO ST
Second Line	:	SUITE 12
City	:	FLORENCE
State	:	SC
Zip	:	29501-4909
Country	:	US
Telephone Number	:	843-678-8998
Fax Number	:	843-678-8999

Authorized Official
Title or Position	:	MANAGER
Name	:	WILLIE DEAN BELL
Credential	:	LPN
Telephone Number	:	843-841-1220

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	02/16/2012

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