Provider Demographics
NPI:1730660671
Name:BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC
Other - Org Name:BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, MDPP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
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:843-987-7400
Mailing Address - Fax:
Practice Address - Street 1:719 OKATIE HWY # 170
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-3963
Practice Address - Country:US
Practice Address - Phone:843-987-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDPE064Medicaid