1821066507 NPI number — BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821066507 NPI number — BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, 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:
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:
1821066507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1320 RIBAUT RD
Provider Second Line Business Mailing Address:
PORT ROYAL MEDICAL CENTER, ADULT MEDICINE
Provider Business Mailing Address City Name:
PORT ROYAL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29935-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-986-0900
Provider Business Mailing Address Fax Number:
843-986-0010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 RIBAUT RD
Provider Second Line Business Practice Location Address:
PORT ROYAL MEDICAL CENTER, ADULT MEDICINE
Provider Business Practice Location Address City Name:
PORT ROYAL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29935-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-986-0900
Provider Business Practice Location Address Fax Number:
843-986-0010
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
ROSALIND
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
843-986-0900

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  15314 , 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)





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