Provider Demographics
NPI:1982765160
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:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:SALZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-525-0045
Mailing Address - Street 1:1076 RIBAUT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5476
Mailing Address - Country:US
Mailing Address - Phone:843-525-0045
Mailing Address - Fax:843-525-0826
Practice Address - Street 1:1076 RIBAUT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5476
Practice Address - Country:US
Practice Address - Phone:843-525-0045
Practice Address - Fax:843-525-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0102Medicaid
C61342Medicare UPIN
SCC613423213Medicare PIN