Provider Demographics
NPI:1720140825
Name:BEAUFORT PEDIATRICS
Entity Type:Organization
Organization Name:BEAUFORT PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:H
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-524-5437
Mailing Address - Street 1:964 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5429
Mailing Address - Country:US
Mailing Address - Phone:843-524-5437
Mailing Address - Fax:843-524-0425
Practice Address - Street 1:964 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5429
Practice Address - Country:US
Practice Address - Phone:843-524-5437
Practice Address - Fax:843-524-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12254261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC156Medicaid