Provider Demographics
NPI:1487817730
Name:BEAUFORT FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:BEAUFORT FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:TRASK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-524-3344
Mailing Address - Street 1:974 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5486
Mailing Address - Country:US
Mailing Address - Phone:843-524-3344
Mailing Address - Fax:843-524-5574
Practice Address - Street 1:974 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5486
Practice Address - Country:US
Practice Address - Phone:843-524-3344
Practice Address - Fax:843-524-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26623261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC045Medicaid
SC423853Medicare Oscar/Certification