Provider Demographics
NPI:1740428176
Name:BEAUFORT REGIONAL PHYSICIANS, LLC
Entity Type:Organization
Organization Name:BEAUFORT REGIONAL PHYSICIANS, LLC
Other - Org Name:WASHINGTON FAMILY MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-975-4203
Mailing Address - Street 1:501 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3565
Mailing Address - Country:US
Mailing Address - Phone:252-975-2667
Mailing Address - Fax:252-975-2507
Practice Address - Street 1:501 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3565
Practice Address - Country:US
Practice Address - Phone:252-975-2667
Practice Address - Fax:252-975-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC022TUOtherBLUE CROSS BLUE SHIELD
NC5950575Medicaid
NC022TUOtherBLUE CROSS BLUE SHIELD