Provider Demographics
NPI:1972541944
Name:BEAUFORT COUNTY ALLERGY LLC
Entity Type:Organization
Organization Name:BEAUFORT COUNTY ALLERGY LLC
Other - Org Name:ALLERGY & ASTHMA CENTER OF HILTON HEAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-689-6442
Mailing Address - Street 1:60 MAIN STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:22926-6603
Mailing Address - Country:US
Mailing Address - Phone:843-689-6442
Mailing Address - Fax:843-689-6158
Practice Address - Street 1:60 MAIN STREET
Practice Address - Street 2:SUITE D
Practice Address - City:HILTON HEAD IS
Practice Address - State:SC
Practice Address - Zip Code:29926-6603
Practice Address - Country:US
Practice Address - Phone:843-689-6442
Practice Address - Fax:843-689-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207K00000X
SC26810207K00000X
26810207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4321Medicaid
SC8420Medicare PIN
SCH6S2868083Medicare UPIN
SCH652868420Medicare UPIN