Provider Demographics
NPI:1235552746
Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:BAXLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:843-522-5140
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING COORDINATOR
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL OBSTETRICS & GYNECOLOGY SPECIALISTS
Practice Address - Street 2:989 RIBAUT RD, STE 210
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5472
Practice Address - Country:US
Practice Address - Phone:843-522-7820
Practice Address - Fax:844-296-2295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAUFORT COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-04
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty