Healthcare Provider Details

I. General information

NPI: 1972541944
Provider Name (Legal Business Name): BEAUFORT COUNTY ALLERGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MAIN STREET SUITE D
HILTON HEAD IS SC
29926-6603
US

IV. Provider business mailing address

60 MAIN STREET SUITE D
HILTON HEAD ISLAND SC
22926-6603
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 TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number26810
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number26810
License Number State

VIII. Authorized Official

Name: MR. THOMAS CHARLES BELLER
Title or Position: OWNER
Credential: MD
Phone: 843-689-6442