Provider Demographics
NPI:1790138014
Name:BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES INC.
Other - Org Name:PORT ROYAL MEDICAL CENTER II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
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 1:721 N OKATIE HWY
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8276
Mailing Address - Country:US
Mailing Address - Phone:874-987-7400
Mailing Address - Fax:
Practice Address - Street 1:2210-B MOSSY OAKS RD.
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1046
Practice Address - Country:US
Practice Address - Phone:843-986-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty