1053464792 NPI number — SLEEP CENTER OF COLUMBIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053464792 NPI number — SLEEP CENTER OF COLUMBIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP CENTER OF COLUMBIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053464792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WELLNESS BLVD
Provider Second Line Business Mailing Address:
SUITE103
Provider Business Mailing Address City Name:
IRMO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29063-2871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-732-2433
Provider Business Mailing Address Fax Number:
803-732-2624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WELLNESS BLVD
Provider Second Line Business Practice Location Address:
SUITE103
Provider Business Practice Location Address City Name:
IRMO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29063-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-732-2433
Provider Business Practice Location Address Fax Number:
803-732-2624
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHELBOURNE
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
803-732-2433

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  1808 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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