Healthcare Provider Details

I. General information

NPI: 1215065180
Provider Name (Legal Business Name): BEAUFORT REGIONAL PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E 12TH ST
WASHINGTON NC
27889-3409
US

IV. Provider business mailing address

608 E 12TH ST
WASHINGTON NC
27889-3409
US

V. Phone/Fax

Practice location:
  • Phone: 252-948-3200
  • Fax: 252-948-3202
Mailing address:
  • Phone: 252-948-3200
  • Fax: 252-948-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN S GERARD
Title or Position: PHYSICIAN PRACTICE ADMINISTRATOR
Credential:
Phone: 252-975-4203