Provider Demographics
NPI:1366436073
Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BEAUFORT COUNTY MEMORIAL HOSPITAL
Other - Org Name:
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 ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5200
Mailing Address - Fax:843-522-5765
Practice Address - Street 1:955 RIBAUT ROAD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5454
Practice Address - Country:US
Practice Address - Phone:843-522-5200
Practice Address - Fax:843-522-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL026282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC270920Medicaid
SC400676Medicaid
SCDPE033Medicaid
SC101376Medicaid
SC3257Medicare ID - Type UnspecifiedMEDICARE PART B
SC400676Medicaid