Provider Demographics
NPI: | 1013224989 |
---|---|
Name: | BEAUFORT COUNTY MEMORIAL HOSPITAL |
Entity Type: | Organization |
Organization Name: | BEAUFORT COUNTY MEMORIAL HOSPITAL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | EDMOND |
Authorized Official - Middle Name: | RUSSELL |
Authorized Official - Last Name: | BAXLEY |
Authorized Official - Suffix: | III |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 843-522-5140 |
Mailing Address - Street 1: | 955 RIBAUT RD |
Mailing Address - Street 2: | |
Mailing Address - City: | BEAUFORT |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29902-5441 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 843-522-5282 |
Mailing Address - Fax: | 843-522-5887 |
Practice Address - Street 1: | 989 RIBAUT RD |
Practice Address - Street 2: | STE. 240 |
Practice Address - City: | BEAUFORT |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29902-5472 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-522-5600 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-09-13 |
Last Update Date: | 2019-11-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 6685 | 261QM0850X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |