Provider Demographics
NPI:1629068531
Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Other - Org Name:BMH INPATIENT PSYCHIATRIC UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BAXLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:843-522-5140
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5200
Mailing Address - Fax:843-522-5975
Practice Address - Street 1:955 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5441
Practice Address - Country:US
Practice Address - Phone:843-522-5200
Practice Address - Fax:843-522-5975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10767AMedicaid
SC10767AMedicaid