Provider Demographics
NPI:1922034370
Name:VASCULAR DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:VASCULAR DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER TECHNOLOGY
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:COTTINGHAM-DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN RVT
Authorized Official - Phone:843-317-1816
Mailing Address - Street 1:500 PAMPLICO HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6051
Mailing Address - Country:US
Mailing Address - Phone:843-664-0882
Mailing Address - Fax:843-317-1815
Practice Address - Street 1:500 PAMPLICO HWY
Practice Address - Street 2:SUITE G
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6051
Practice Address - Country:US
Practice Address - Phone:843-664-0882
Practice Address - Fax:843-317-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11178 SC LICENSURE #2084N0400X
18678 ARDMS#2471S1302X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0037Medicaid
SCPL0037Medicaid