Provider Demographics
NPI:1174769764
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:
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
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5785
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:989 RIBAUT RD STE 130
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-522-7800
Practice Address - Fax:843-522-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP8977Medicaid