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	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1831764927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUFORT COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	BEAUFORT COUNTY MEMORIAL HOSPITAL
Second Line	:	955 RIBAUT RD
City	:	BEAUFORT
State	:	SC
Zip	:	29902-5441
Country	:	US
Telephone Number	:	843-522-5790
Fax Number	:

Provider Business Practice Location Address
First Line	:	BEAUFORT MEMORIAL PULMONARY SPECIALIST
Second Line	:	122 OKATIE CENTER BLVD N STE 300
City	:	OKATIE
State	:	SC
Zip	:	29909-3782
Country	:	US
Telephone Number	:	843-522-5775
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL STAFF COORDINATOR
Name	:	TRIMMELL S SIMMONS
Credential	:
Telephone Number	:	843-522-5790

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	05/21/2021

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