Healthcare Provider Details

I. General information

NPI: 1235552746
Provider Name (Legal Business Name): BEAUFORT COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEAUFORT MEMORIAL OBSTETRICS & GYNECOLOGY SPECIALISTS 989 RIBAUT RD, STE 210
BEAUFORT SC
29902-5472
US

IV. Provider business mailing address

955 RIBAUT RD BMAC CREDENTIALING COORDINATOR
BEAUFORT SC
29902-5441
US

V. Phone/Fax

Practice location:
  • Phone: 843-522-7820
  • Fax: 844-296-2295
Mailing address:
  • Phone: 843-522-5674
  • Fax: 843-522-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36465
License Number StateSC

VIII. Authorized Official

Name: MR. EDMOND RUSSELL BAXLEY III
Title or Position: CEO
Credential:
Phone: 843-522-5140