Provider Demographics
NPI:1417008459
Name:BEAUFORT GASTROENTEROLOGY
Entity Type:Organization
Organization Name:BEAUFORT GASTROENTEROLOGY
Other - Org Name:BERNARD B VINOSKI,JR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:VINOSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-522-1550
Mailing Address - Street 1:989 RIBAUT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5426
Mailing Address - Country:US
Mailing Address - Phone:843-522-1550
Mailing Address - Fax:843-522-8115
Practice Address - Street 1:989 RIBAUT RD STE 300
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5426
Practice Address - Country:US
Practice Address - Phone:843-522-1550
Practice Address - Fax:843-522-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC152676Medicaid
SCGP1219Medicaid
SC152676Medicaid
SCGP1219Medicaid
SC6754Medicare PIN