Provider Demographics
NPI:1700459567
Name:BEAUFORT ORTHOPAEDIC SPORTS AND SPINE CENTER LLC
Entity Type:Organization
Organization Name:BEAUFORT ORTHOPAEDIC SPORTS AND SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-525-0902
Mailing Address - Street 1:1076 RIBAUT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5477
Mailing Address - Country:US
Mailing Address - Phone:843-525-0045
Mailing Address - Fax:843-525-0826
Practice Address - Street 1:39 HOSPITAL CENTER CMNS
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2837
Practice Address - Country:US
Practice Address - Phone:843-681-2363
Practice Address - Fax:843-342-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty