Provider Demographics
NPI:1508994872
Name:BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICE INC
Entity Type:Organization
Organization Name:BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICE INC
Other - Org Name:BJHCHS PORT ROYAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:POLKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-987-7400
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-2605
Mailing Address - Country:US
Mailing Address - Phone:843-322-1832
Mailing Address - Fax:843-522-1286
Practice Address - Street 1:1320 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1118
Practice Address - Country:US
Practice Address - Phone:843-332-1832
Practice Address - Fax:843-522-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC68943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC768947Medicaid
2092251OtherPK
421915Medicare PIN