Provider Demographics
NPI:1083842264
Name:BEAUFORT COUNTY HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:BEAUFORT COUNTY HOSPITAL ASSOCIATION INC
Other - Org Name:TIDELAND PSYCHIATRIC SERVICES PLYMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-975-4203
Mailing Address - Street 1:804 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-2224
Mailing Address - Country:US
Mailing Address - Phone:252-793-1154
Mailing Address - Fax:252-793-3860
Practice Address - Street 1:804 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-2224
Practice Address - Country:US
Practice Address - Phone:252-793-1154
Practice Address - Fax:252-793-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty