MEDICARE: BEAUFORT COUNTY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	31544	SC

General Provider Information

NPI Number	:	1235430745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUFORT COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	1716 RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1927
Country	:	US
Telephone Number	:	843-522-7890
Fax Number	:	843-522-7889

Provider Business Practice Location Address
First Line	:	1716 RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1927
Country	:	US
Telephone Number	:	843-522-7890
Fax Number	:	843-522-7889

Authorized Official
Title or Position	:	CEO
Name	:	MR. EDMOND RUSSELL BAXLEY III
Credential	:
Telephone Number	:	843-522-5140

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	11/06/2019

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