Provider Demographics
NPI:1720212129
Name:BEAUFORT COUNTY MEMORIAL HOSPTIAL
Entity Type:Organization
Organization Name:BEAUFORT COUNTY MEMORIAL HOSPTIAL
Other - Org Name:BEAUFORT MEMORIAL SURGICAL SPECIALISTS WCC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:1055 RIBAUT RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5423
Mailing Address - Country:US
Mailing Address - Phone:843-522-5742
Mailing Address - Fax:
Practice Address - Street 1:989 RIBAUT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5472
Practice Address - Country:US
Practice Address - Phone:843-522-5742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty