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General NPI Number Information
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NPI Number | 1235430745
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Entity Type | Organization
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Legal Business Name | BEAUFORT COUNTY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 1716 RIBAUT RD
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City | PORT ROYAL
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State | SC
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Zip | 29935-1927
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Country | US
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Telephone | 843-522-7890
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Fax | 843-522-7889
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Provider Business Mailing Address
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Address Line | 1716 RIBAUT RD
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City | PORT ROYAL
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State | SC
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Zip | 29935-1927
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Country | US
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Telephone | 843-522-7890
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Fax | 843-522-7889
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Authorized Official
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Title or Position | CEO
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Name | MR. EDMOND RUSSELL BAXLEY III
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Credential |
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Telephone | 843-522-5140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 31544
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License Number State | SC
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