Provider Demographics
NPI:1285860098
Name:PALMETTO VEIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:PALMETTO VEIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:843-820-5372
Mailing Address - Street 1:9263 MEDICAL PLAZA DR
Mailing Address - Street 2:STE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7112
Mailing Address - Country:US
Mailing Address - Phone:843-553-7070
Mailing Address - Fax:843-553-2223
Practice Address - Street 1:9313 MEDICAL PLAZA DR
Practice Address - Street 2:STE 303
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9155
Practice Address - Country:US
Practice Address - Phone:843-820-5372
Practice Address - Fax:843-824-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6391261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5265Medicaid
SC9316Medicare UPIN