Provider Demographics
NPI:1407864184
Name:BEAUFORT OB/GYN ASSOCIATES PA
Entity Type:Organization
Organization Name:BEAUFORT OB/GYN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-524-8151
Mailing Address - Street 1:989 RIBAUT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5481
Mailing Address - Country:US
Mailing Address - Phone:843-524-8151
Mailing Address - Fax:843-524-1954
Practice Address - Street 1:989 RIBAUT RD STE 210
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5481
Practice Address - Country:US
Practice Address - Phone:843-524-8151
Practice Address - Fax:843-524-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT70064Medicaid
SC226179/PA0726Medicaid
SC187149/PA0726Medicaid
SC075723/PA0726Medicaid
SC187149/PA0726Medicaid
SCNSC0836980001Medicare ID - Type UnspecifiedPATRICIA THOMPSON
SCG15309Medicare UPIN
SCG07281Medicare UPIN
SCG27372Medicare UPIN
SCD17533Medicare UPIN
SCT70064Medicaid
SC075723/PA0726Medicaid