Provider Demographics
NPI:1447714993
Name:BEACH MEDICAL WEIGHT LOSS NORTH AUGUSTA SC LLC
Entity type:Organization
Organization Name:BEACH MEDICAL WEIGHT LOSS NORTH AUGUSTA SC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-426-8882
Mailing Address - Street 1:220 EDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-1941
Mailing Address - Country:US
Mailing Address - Phone:803-426-8882
Mailing Address - Fax:803-426-8910
Practice Address - Street 1:220 EDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-1941
Practice Address - Country:US
Practice Address - Phone:803-426-8882
Practice Address - Fax:803-426-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care