MEDICARE: BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	1438	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2088929	OTHER		PK

General Provider Information

NPI Number	:	1235273939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUFORT-JASPER-HAMPTON COMPREHENSIVE HEALTH SERVICE INC

Provider Business Mailing Address
First Line	:	PO BOX 357
Second Line	:
City	:	RIDGELAND
State	:	SC
Zip	:	29936-2605
Country	:	US
Telephone Number	:	843-322-1872
Fax Number	:	843-838-2086

Provider Business Practice Location Address
First Line	:	6315 JONATHAN FRANCIS SR RD
Second Line	:
City	:	ST HELENA IS
State	:	SC
Zip	:	29920-5310
Country	:	US
Telephone Number	:	843-322-1872
Fax Number	:	843-838-2086

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	FAITH LAWRENCE POLKEY
Credential	:	MD
Telephone Number	:	843-987-7400

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	01/18/2023

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