# VEIN CENTER MD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124218920
- **Authorized official:** MR. ISAAC SHEPPARD FUNDERBURK III (CEO)
- **Authorized official phone:** (803) 534-6550

## Contact information

- **Practice address:** 870 HOLLY ST, ORANGEBURG, SC 29115-4831
- **Practice address phone:** (803) 534-6550
- **Mailing address:** 870 HOLLY ST, ORANGEBURG, SC 29115-4831
- **Mailing address phone:** (803) 534-6550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 2007-0000207 | SC | Yes |

## Other

- **Enumeration date:** 07/27/2007
- **Last updated:** 07/27/2007