Healthcare Provider Details

I. General information

NPI: 1134951916
Provider Name (Legal Business Name): VAST MEDICAL COLLECTIONS & CAREGIVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 FOX HOLLOW CT
MARION SC
29571-6725
US

IV. Provider business mailing address

1622 FOX HOLLOW CT
MARION SC
29571-6725
US

V. Phone/Fax

Practice location:
  • Phone: 843-430-5456
  • Fax: 843-433-8655
Mailing address:
  • Phone: 843-624-1356
  • Fax: 208-291-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code331L00000X
TaxonomyBlood Bank
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: VERONICA WILLIAMS
Title or Position: OWNER
Credential:
Phone: 843-624-1356