Provider Demographics
NPI:1164526877
Name:BEAUFORT COUNTY HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:BEAUFORT COUNTY HOSPITAL ASSOCIATION INC
Other - Org Name:BEAUFORT COUNTY HOSPITAL PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
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 1:628 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3409
Mailing Address - Country:US
Mailing Address - Phone:252-975-4100
Mailing Address - Fax:252-948-4829
Practice Address - Street 1:628 E 12TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3409
Practice Address - Country:US
Practice Address - Phone:252-975-4100
Practice Address - Fax:252-948-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC870765JMedicaid
NC8000187Medicaid
NC8907619Medicaid
NC8907619Medicaid
NC235009AMedicare ID - Type Unspecified
NC870765JMedicaid