Healthcare Provider Details

I. General information

NPI: 1174769764
Provider Name (Legal Business Name): BEAUFORT COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 RIBAUT RD STE 130
BEAUFORT SC
29902
US

IV. Provider business mailing address

955 RIBAUT RD BMAC CREDENTIALING
BEAUFORT SC
29902-5441
US

V. Phone/Fax

Practice location:
  • Phone: 843-522-7800
  • Fax: 843-522-7800
Mailing address:
  • Phone: 843-522-5785
  • Fax: 843-522-5678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

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