Provider Demographics
NPI:1912485830
Name:HILTON HEAD REGIONAL PHYSICIAN NETWORK - GEORGIA, LLC
Entity Type:Organization
Organization Name:HILTON HEAD REGIONAL PHYSICIAN NETWORK - GEORGIA, LLC
Other - Org Name:RIVERSIDE WOMENS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CFO TPR TENET
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-893-2532
Mailing Address - Street 1:PO BOX 23894
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4489
Mailing Address - Country:US
Mailing Address - Phone:708-342-6900
Mailing Address - Fax:708-614-1270
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 604B
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4052
Practice Address - Country:US
Practice Address - Phone:912-450-0957
Practice Address - Fax:912-450-0967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty