MEDICARE: HEAVENLY HEART TRANSPORTATION 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	172A00000X	Driver

General Provider Information

NPI Number	:	1922961382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY HEART TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3294 ASHLEY PHOSPHATE RD STE 2D
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-8465
Country	:	US
Telephone Number	:	843-330-6774
Fax Number	:

Provider Business Practice Location Address
First Line	:	3294 ASHLEY PHOSPHATE RD STE 2D
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-8465
Country	:	US
Telephone Number	:	843-330-6774
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TAMMY SMITH
Credential	:
Telephone Number	:	843-330-6774

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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