MEDICARE: JACQUELINE ALLEN PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1699633875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACQUELINE ALLEN PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	6539 TWO NOTCH RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7463
Country	:	US
Telephone Number	:	803-381-0756
Fax Number	:

Provider Business Practice Location Address
First Line	:	6539 TWO NOTCH RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7463
Country	:	US
Telephone Number	:	803-381-0756
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JACQUELINE ALLEN
Credential	:	NP
Telephone Number	:	803-381-0756

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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