Provider Demographics
NPI: | 1497516538 |
---|---|
Name: | HILTON HEAD REGIONAL PHYSICIAN GROUP LLC |
Entity Type: | Organization |
Organization Name: | HILTON HEAD REGIONAL PHYSICIAN GROUP LLC |
Other - Org Name: | HILTON HEAD ORTHOPEDICS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | RCS MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DOREATHA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ROGERS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 980-302-7992 |
Mailing Address - Street 1: | PO BOX 37643 |
Mailing Address - Street 2: | |
Mailing Address - City: | BELFAST |
Mailing Address - State: | ME |
Mailing Address - Zip Code: | 04915-1218 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8 HOSPITAL CENTER BLVD STE 110 |
Practice Address - Street 2: | |
Practice Address - City: | HILTON HEAD |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29926-8701 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-682-7480 |
Practice Address - Fax: | 843-681-9169 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-01-16 |
Last Update Date: | 2024-01-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty |