Provider Demographics
NPI:1447241740
Name:BEAUFORT FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:BEAUFORT FAMILY MEDICINE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:LUCIUS
Authorized Official - Last Name:LAFFITTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-524-3344
Mailing Address - Street 1:974 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5486
Mailing Address - Country:US
Mailing Address - Phone:843-524-3344
Mailing Address - Fax:843-524-5574
Practice Address - Street 1:974 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5486
Practice Address - Country:US
Practice Address - Phone:843-524-3344
Practice Address - Fax:843-524-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0057Medicaid
SC423853Medicare ID - Type Unspecified