MEDICARE: PALLIATIVE CARE AT HEART, 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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1801426937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLIATIVE CARE AT HEART, LLC

Provider Business Mailing Address
First Line	:	134 COLUMBUS ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-4809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 BERTRAND DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-4110
Country	:	US
Telephone Number	:	337-232-8159
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CARLA DAVIS
Credential	:
Telephone Number	:	843-410-6691

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	04/21/2021

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