Provider Demographics
NPI:1881679470
Name:BEAUFORT MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:BEAUFORT MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-379-2800
Mailing Address - Street 1:2127 BOUNDARY ST
Mailing Address - Street 2:STE 5
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-3827
Mailing Address - Country:US
Mailing Address - Phone:843-379-2800
Mailing Address - Fax:843-379-2801
Practice Address - Street 1:2127 BOUNDARY ST
Practice Address - Street 2:STE 5
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-3827
Practice Address - Country:US
Practice Address - Phone:843-379-2800
Practice Address - Fax:843-379-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2043Medicaid
SC=========OtherBCBS SOUTH CAROLINA
SCDE2043Medicaid
SC=========OtherTRI CARE