Healthcare Provider Details

I. General information

NPI: 1609484625
Provider Name (Legal Business Name): PALLIATIVE CARE AT HEART, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BLARNEY DR STE 204
COLUMBIA SC
29223-6291
US

IV. Provider business mailing address

115 BLARNEY DR STE 204
COLUMBIA SC
29223-6291
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-9323
  • Fax:
Mailing address:
  • Phone: 803-699-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JIM PETRUS
Title or Position: VP OF FINANCE
Credential:
Phone: 843-410-6691