Organization
SOUTH CAROLINA ENT ALLERGY & SLEEP MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA LEA KIRBY (CHIEF REVENUE OFFICER)
(803) 424-2207
Entity
Organization
Contact information
Practice address
15 EXCHANGE DR, LUGOFF, SC 29078-9198
(803) 408-3277
(803) 408-3277
Mailing address
PO BOX 520, LUGOFF, SC 29078-0520
(803) 408-3277
(803) 408-3277
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YP0228X
Pediatric Otolaryngology Physician
—
—
207YS0012X
Sleep Medicine (Otolaryngology) Physician
—
—
225100000X
Physical Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE5192
UNSPECIFIED
SC
05
—
GP4316
—
SC
Enumeration date
07/10/2006
Last updated
05/26/2020
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