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General NPI Number Information
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NPI Number | 1285860098
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Entity Type | Organization
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Legal Business Name | PALMETTO VEIN SPECIALISTS, LLC
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 9313 MEDICAL PLAZA DR STE 303
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City | CHARLESTON
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State | SC
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Zip | 29406-9155
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Country | US
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Telephone | 843-820-5372
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Fax | 843-824-8359
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Provider Business Mailing Address
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Address Line | 9263 MEDICAL PLAZA DR STE B
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City | CHARLESTON
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State | SC
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Zip | 29406-7112
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Country | US
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Telephone | 843-553-7070
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Fax | 843-553-2223
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | KAREN MCCARDLE
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Credential | RN
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Telephone | 843-820-5372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 6391
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License Number State | SC
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