Provider Demographics
NPI:1194868612
Name:CAROLINA SLEEP AND RESPIRATORY, LLC
Entity type:Organization
Organization Name:CAROLINA SLEEP AND RESPIRATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:910-639-9113
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-0009
Mailing Address - Country:US
Mailing Address - Phone:910-862-5183
Mailing Address - Fax:910-862-1257
Practice Address - Street 1:411 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-9628
Practice Address - Country:US
Practice Address - Phone:910-897-2296
Practice Address - Fax:910-694-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015NNMedicaid
NC89015NNMedicaid