Healthcare Provider Details

I. General information

NPI: 1922034370
Provider Name (Legal Business Name): VASCULAR DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PAMPLICO HWY SUITE G
FLORENCE SC
29505-6051
US

IV. Provider business mailing address

500 PAMPLICO HWY SUITE G
FLORENCE SC
29505-6051
US

V. Phone/Fax

Practice location:
  • Phone: 843-664-0882
  • Fax: 843-317-1815
Mailing address:
  • Phone: 843-664-0882
  • Fax: 843-317-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number11178 SC LICENSURE #
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number18678 ARDMS#
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBRA V COTTINGHAM-DANIELS
Title or Position: CO OWNER TECHNOLOGY
Credential: LPN RVT
Phone: 843-317-1816