1144364845 NPI number — BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICE INC

Table of content: (NPI 1144364845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144364845 NPI number — BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BJHCHS SHELDON PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144364845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 357
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29936-2605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-322-1871
Provider Business Mailing Address Fax Number:
843-466-0849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 PAIGE POINT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELDON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29941-0008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-322-1871
Provider Business Practice Location Address Fax Number:
843-466-0849
Provider Enumeration Date:
02/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POLKEY
Authorized Official First Name:
FAITH
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
843-987-7400

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 1523 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2088977 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 715233 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".