COASTAL VASCULAR & VEIN CENTER PA NPI 1023157575

NPI Information

NPI: 1023157575
Provider Name: COASTAL VASCULAR & VEIN CENTER PA
Classification: Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

CLIA Number: 42D2291952

Address:
1327 ASHLEY RIVER RD
CHARLESTON, SC
ZIP 29407
Phone: (843) 577-4551
Get Directions

COASTAL VASCULAR & VEIN CENTER PA is a vascular surgery surgery in Charleston, SC. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. COASTAL VASCULAR & VEIN CENTER PA NPI is 1023157575. The provider is registered as an organization entity type.

The provider's business location address is:

1327 ASHLEY RIVER RD
CHARLESTON, SC
ZIP 29407-384
Phone: (843) 577-4551
Fax: (843) 577-2227

The provider's authorized official is Laura Gillum .
The authorized official title is Coder and has the following contact phone number (843) 300-3588.

The CLIA number assigned to this NPI record is 42D2291952 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/5/2007 and was last updated on 10/28/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	335E00000X	Prosthetic/Orthotic Supplier				No
2	2086S0129X	Surgery	Vascular Surgery		SOUTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	PA1729	MEDICAID	SOUTH CAROLINA
2	0489056	OTHER	SOUTH CAROLINA	AETNA
3	610303400	OTHER	SOUTH CAROLINA	U S DEPARTMENT OF LABOR
4	6174310001	MEDICARE NSC
5	1841	MEDICARE PIN	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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