1366676769 NPI number — BEAUFORT COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1366676769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366676769 NPI number — BEAUFORT COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAUFORT COUNTY MEMORIAL HOSPITAL
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:
Provider Other Organization Name Type Code:
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:
1366676769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
955 RIBAUT RD
Provider Second Line Business Mailing Address:
BMAC CREDENTIALING COORDINATOR
Provider Business Mailing Address City Name:
BEAUFORT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29902-5441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-522-5674
Provider Business Mailing Address Fax Number:
843-522-5678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BEAUFORT MEMORIAL SURGICAL SPECIALISTS
Provider Second Line Business Practice Location Address:
1000 PINE STREET
Provider Business Practice Location Address City Name:
VARNVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29944-0969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
842-524-8171
Provider Business Practice Location Address Fax Number:
844-296-2307
Provider Enumeration Date:
05/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BAXLEY
Authorized Official First Name:
EDMOND
Authorized Official Middle Name:
RUSSELL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
843-522-5140

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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