Provider Demographics
NPI:1346474996
Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Other - Org Name:BEAUFORT MEMORIAL SURGICAL SPECIALIST
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 1:955 RIBAUT ROAD
Mailing Address - Street 2:BMAC CREDENTIALING COORDINATOR
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL SURGICAL SPECIALISTS
Practice Address - Street 2:989 RIBAUT RD, STE 360
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5427
Practice Address - Country:US
Practice Address - Phone:843-524-8171
Practice Address - Fax:844-296-2307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUFORT COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1346474996OtherBCBSSC
SC155666800OtherUS DEPT OF LABOR
SC42D0957596OtherCLIA
SCGP8668Medicaid