# SOUTH CAROLINA ENT ALLERGY & SLEEP MEDICINE PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134153083
- **Authorized official:** PAMELA LEA KIRBY (CHIEF REVENUE OFFICER)
- **Authorized official phone:** (803) 424-2207

## Contact information

- **Practice address:** 15 EXCHANGE DR, LUGOFF, SC 29078-9198
- **Practice address phone:** (803) 408-3277
- **Practice address fax:** (803) 408-3277
- **Mailing address:** PO BOX 520, LUGOFF, SC 29078-0520
- **Mailing address phone:** (803) 408-3277
- **Mailing address fax:** (803) 408-3277

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | Yes |
| 207Y00000X | Otolaryngology Physician | — | — | Yes |
| 207YP0228X | Pediatric Otolaryngology Physician | — | NULL | — |
| 207YP0228X | Pediatric Otolaryngology Physician | — | — | — |
| 207YS0012X | Sleep Medicine (Otolaryngology) Physician | — | NULL | — |
| 207YS0012X | Sleep Medicine (Otolaryngology) Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 07/10/2006
- **Last updated:** 05/26/2020