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?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty