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General NPI Number Information
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NPI Number | 1346474996
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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 | 05/12/2009
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | BEAUFORT MEMORIAL SURGICAL SPECIALISTS 989 RIBAUT RD, STE 360
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City | BEAUFORT
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State | SC
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Zip | 29902-5427
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Country | US
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Telephone | 843-524-8171
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Fax | 844-296-2307
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Provider Business Mailing Address
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Address Line | 955 RIBAUT ROAD BMAC CREDENTIALING COORDINATOR
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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 | 843-522-5674
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Fax | 843-522-5678
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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