Provider Demographics
NPI:1780340752
Name:VIZER HEALTH LLC
Entity type:Organization
Organization Name:VIZER HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DIANNE BILLIE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:914-359-7442
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-0141
Mailing Address - Country:US
Mailing Address - Phone:914-359-7442
Mailing Address - Fax:
Practice Address - Street 1:188 S PIKE E
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2131
Practice Address - Country:US
Practice Address - Phone:914-359-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC23707OtherNURSE PRACTITIONER LICENSE NUMBER