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1740119080 NPI number — PRECISION VEIN & VASCULAR OF SC LLC

NPI Number: 1740119080
Health Care Provider/Practitioner: PRECISION VEIN & VASCULAR OF SC LLC

Information about “1740119080” NPI (PRECISION VEIN & VASCULAR OF SC LLC) exists in 1740119080 in HTML format HTML  |  1740119080 in plain Text format TXT  |  1740119080 in PDF (Portable Document Format) PDF  |  1740119080 in an XML format XML  formats.

NPI Number : 1740119080 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740119080",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PRECISION VEIN & VASCULAR OF SC LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1250 E 3900 S STE 440",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SLC",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84124-1349",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "864-813-7910",
    "MailingAddressFaxNumber": "864-813-7911",
    "FirstLinePracticeLocationAddress": "103 HARTH PL STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SUMMERVILLE",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29485-8107",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "864-813-7910",
    "PracticeLocationAddressFaxNumber": "864-813-7911",
    "EnumerationDate": "05/14/2026",
    "LastUpdateDate": "05/14/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LILJENQUIST",
    "AuthorizedOfficialFirstName": "BRAD",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "864-813-7910",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM1300X",
        "TaxonomyName": "Multi-Specialty Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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