Provider Demographics
NPI:1497526164
Name:HILTON HEAD REGIONAL PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:HILTON HEAD REGIONAL PHYSICIAN GROUP LLC
Other - Org Name:OKATIE SURGICAL PARTNERS
Other - Org Type:Other Name
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 1:75 BAYLOR DR STE 290
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8965
Practice Address - Country:US
Practice Address - Phone:843-689-1326
Practice Address - Fax:843-706-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty