Provider Demographics
NPI:1578259750
Name:COASTAL VASCULAR AND VEIN INSTITUTE LLC
Entity Type:Organization
Organization Name:COASTAL VASCULAR AND VEIN INSTITUTE LLC
Other - Org Name:COASTAL VASCULAR AND VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KEEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-577-4551
Mailing Address - Street 1:1327 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5384
Mailing Address - Country:US
Mailing Address - Phone:843-577-4551
Mailing Address - Fax:
Practice Address - Street 1:1229 NEXTON PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2167
Practice Address - Country:US
Practice Address - Phone:843-577-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1023157575Medicaid