Active NPI
Palmetto Health
Doing business as Baptist Vascular Lab
- Vascular & Interventional Radiology Physician
- Columbia, SC
National Provider Identifier
1336311901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular & Interventional Radiology Physician
- Legal business name
- PALMETTO HEALTH
- Doing business as
- Baptist Vascular Lab
- Practice address
- Taylor at Marion St
Columbia, SC 29220-0001 - Phone
- (803) 296-5162
- Fax
- (803) 296-5594
- NPI assigned
- Mar 24, 2008
- Last updated
- Sep 28, 2010
- Organization subpart
- Yes
- Parent organization
- PALMETTO HEALTH
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Darrell C Coven
- Title
- Director, Ambulatory SVCS - Finance
- Phone
- (803) 296-7301
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular & Interventional Radiology Physician | 2085R0204X | Primary |
Addresses
Primary practice location
Taylor at Marion St
Columbia, SC 29220-0001
Mailing address
PO Box 402145
Atlanta, GA 30384-2145
Phone (803) 296-7305
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP4875 | Medicaid | SC |
Other names 1
- Baptist Vascular Lab
National Provider Directory
National Provider Directory- Part of
- Palmetto Health
Locations
Taylor At Marion St
Columbia, SC 29220
Phone (803) 296-3097
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206316800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1285632000000",
"number": "1336311901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 402145",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303842145",
"telephone_number": "803-296-7305",
"fax_number": "803-296-7330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "TAYLOR AT MARION ST",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292200001",
"telephone_number": "803-296-5162",
"fax_number": "803-296-5594"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PALMETTO HEALTH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PALMETTO HEALTH",
"enumeration_date": "2008-03-24",
"last_updated": "2010-09-28",
"status": "A",
"authorized_official_last_name": "COVEN",
"authorized_official_first_name": "DARRELL",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "DIRECTOR, AMBULATORY SVCS - FINANCE",
"authorized_official_telephone_number": "803-296-7301"
},
"taxonomies": [
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP4875",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Baptist Vascular Lab",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Columbia, SC
- Palmetto Health (Premier Orthopedic Specialists)
- Palmetto Health (First Care)
- Palmetto Health (Palmetto Surgical Associates)
- Palmetto Health (Diagnostic Center for Women)
- Palmetto Health
- Palmetto Health (Palmetto Health Pharmacy 10 MP)
- Palmetto Health (Carolina Colon and Rectal Surgeons)
- Palmetto Health (Palmetto Health Counseling - Columbia)
- Palmetto Health (Palmetto Health Rehabilitation Center SNF)
- Palmetto Health (Palmetto Health Richland Enhance)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.