Organization
COASTAL VASCULAR & VEIN CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA GILLUM CPC (CODER)
(843) 300-3588
Entity
Organization
Contact information
Practice address
1327 ASHLEY RIVER RD, CHARLESTON, SC 29407-5384
(843) 577-4551
(843) 577-2227
Mailing address
1327 ASHLEY RIVER RD, CHARLESTON, SC 29407-5384
(843) 577-4551
(843) 577-2227
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
SC
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0489056
AETNA
SC
01
—
610303400
U S DEPARTMENT OF LABOR
SC
05
—
PA1729
—
SC
Enumeration date
02/05/2007
Last updated
03/12/2025
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