Healthcare Provider Details

I. General information

NPI: 1275299331
Provider Name (Legal Business Name): ALLHEART HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 S PIKE E
SUMTER SC
29150-2131
US

IV. Provider business mailing address

PO BOX 141
SUMTER SC
29151-0141
US

V. Phone/Fax

Practice location:
  • Phone: 914-359-7442
  • Fax:
Mailing address:
  • Phone: 803-580-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY DIANNE BILLIE JACKSON
Title or Position: OWNER
Credential: NP
Phone: 803-580-4747