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General NPI Number Information
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NPI Number | 1023941879
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Entity Type | Organization
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Legal Business Name | SOUTH OF BROAD HEALTHCARE
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 10 INNOVATION DR
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City | BLUFFTON
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State | SC
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Zip | 29910-5159
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Country | US
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Telephone | 843-522-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 955 RIBAUT RD
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City | BEAUFORT
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State | SC
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Zip | 29902-5441
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Country | US
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Telephone | 843-522-5140
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Fax | 843-522-5724
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | EDMOND RUSSELL BAXLEY III
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Credential |
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Telephone | 843-687-9402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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