Healthcare Provider Details

I. General information

NPI: 1891004354
Provider Name (Legal Business Name): BEAUFORT COUNTY ALLERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NEW RIVER PKWY BLDG. 6, SUITE 11
HARDEEVILLE SC
29927-4450
US

IV. Provider business mailing address

PO BOX 22660
HILTON HEAD SC
29925-2660
US

V. Phone/Fax

Practice location:
  • Phone: 843-689-6442
  • Fax: 843-689-6158
Mailing address:
  • Phone: 843-689-6442
  • Fax: 843-689-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS CHARLES BELLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-689-6442