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General NPI Number Information
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NPI Number | 1386840536
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Entity Type | Organization
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Legal Business Name | THE VEIN CLINIC, LLC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 1725 DEVONSHIRE DR
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City | COLUMBIA
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State | SC
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Zip | 29204-2404
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Country | US
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Telephone | 803-253-8667
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Fax | 803-253-8670
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Provider Business Mailing Address
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Address Line | 1725 DEVONSHIRE DR
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City | COLUMBIA
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State | SC
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Zip | 29204-2404
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Country | US
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Telephone | 803-253-8667
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Fax | 803-253-8670
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Authorized Official
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Title or Position | PHYSICIAN
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Name | REMBERT NEAL REYNOLDS
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Credential | M.D.
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Telephone | 803-253-8667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9552
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License Number State | SC
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