Provider Demographics
NPI:1235430745
Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Other - Org Name:BEAUFORT MEMORIAL CENTER FOR DIGESTIVE DISEASES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:1716 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1927
Mailing Address - Country:US
Mailing Address - Phone:843-522-7890
Mailing Address - Fax:843-522-7889
Practice Address - Street 1:1716 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1927
Practice Address - Country:US
Practice Address - Phone:843-522-7890
Practice Address - Fax:843-522-7889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUFORT COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-15
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31544207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty