Healthcare Provider Details

I. General information

NPI: 1649276148
Provider Name (Legal Business Name): BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 N OKATIE HWY
RIDGELAND SC
29936-8276
US

IV. Provider business mailing address

PO BOX 357
RIDGELAND SC
29936-2605
US

V. Phone/Fax

Practice location:
  • Phone: 843-987-7400
  • Fax: 843-987-0559
Mailing address:
  • Phone: 843-987-7400
  • Fax: 843-987-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberEPSD&T
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number295441
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberCBP005
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberFQC008
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberFQC008
License Number StateSC

VIII. Authorized Official

Name: FAITH LAWRENCE POLKEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 843-987-7400