Provider Demographics
NPI:1336180165
Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Other - Org Name:BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BAXLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:843-522-5140
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-7843
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP
Practice Address - Street 2:300 MIDTOWN
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-5200
Practice Address - Country:US
Practice Address - Phone:843-770-0404
Practice Address - Fax:844-296-2308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUFORT COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC270920Medicaid
SC101376Medicaid
3257OtherMEDICARE ID-TYPE UNSPECIFIED MEDICARE PART B
SCGP6561Medicaid
3257OtherMEDICARE ID-TYPE UNSPECIFIED MEDICARE PART B
SCDPE033Medicaid