Provider Demographics
NPI:1407375991
Name:RIBAUT MEDICAL PARTNERS, LLC
Entity Type:Organization
Organization Name:RIBAUT MEDICAL PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:TRASK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-524-2001
Mailing Address - Street 1:1094 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5437
Mailing Address - Country:US
Mailing Address - Phone:843-524-2001
Mailing Address - Fax:
Practice Address - Street 1:1094 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5437
Practice Address - Country:US
Practice Address - Phone:843-524-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD26623207Q00000X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty