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General NPI Number Information
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NPI Number | 1578259750
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Entity Type | Organization
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Legal Business Name | COASTAL VASCULAR AND VEIN INSTITUTE LLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 1229 NEXTON PKWY
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City | SUMMERVILLE
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State | SC
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Zip | 29486-2167
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Country | US
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Telephone | 843-577-4551
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 ASHLEY RIVER RD
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City | CHARLESTON
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State | SC
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Zip | 29407-5384
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Country | US
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Telephone | 843-577-4551
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CRAIG KILGORE
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Credential |
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Telephone | 423-646-1033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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