1659353373 NPI number — PALMETTO SLEEP & DIAGNOSTIC, LLC

Table of content: ERIC PAUL VELAZQUEZ MD (NPI 1518385111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659353373 NPI number — PALMETTO SLEEP & DIAGNOSTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO SLEEP & DIAGNOSTIC, LLC
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:
1659353373
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:
527 MILLS AVE
Provider Second Line Business Mailing Address:
SUITE 101-B
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29605-5602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-242-8884
Provider Business Mailing Address Fax Number:
864-242-2585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9657 OCEAN HWY
Provider Second Line Business Practice Location Address:
SUITE 4-B
Provider Business Practice Location Address City Name:
PAWLEYS ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29585-7425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-235-9831
Provider Business Practice Location Address Fax Number:
864-235-9853
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARNES
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
864-242-8884

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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