Healthcare Provider Details

I. General information

NPI: 1194264457
Provider Name (Legal Business Name): BHS PHYSICIAN SERVICES OF SOUTH CAROLINA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MAIN ST
HILTON HEAD ISLAND SC
29926-1667
US

IV. Provider business mailing address

160 CHUBB AVE
LYNDHURST NJ
07071-3526
US

V. Phone/Fax

Practice location:
  • Phone: 973-330-9415
  • Fax:
Mailing address:
  • Phone: 973-330-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS JONATHAN HOREY
Title or Position: PRESIDENT
Credential:
Phone: 973-330-9415