MEDICARE: BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208D00000X	General Practice Physician
2	261QC1500X	Community Health Clinic/Center
3	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1790138014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	721 N OKATIE HWY
Second Line	:
City	:	RIDGELAND
State	:	SC
Zip	:	29936-8276
Country	:	US
Telephone Number	:	874-987-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210-B MOSSY OAKS RD.
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1046
Country	:	US
Telephone Number	:	843-986-0900
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ROLAND J GARDNER
Credential	:
Telephone Number	:	843-987-7400

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	05/13/2022

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