Provider Demographics
NPI:1942554886
Name:BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-987-7400
Mailing Address - Street 1:721 N OKATIE HWY # 170
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8276
Mailing Address - Country:US
Mailing Address - Phone:843-987-7400
Mailing Address - Fax:843-987-7498
Practice Address - Street 1:1320 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1118
Practice Address - Country:US
Practice Address - Phone:843-986-0900
Practice Address - Fax:843-986-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCGP2554261QC1500X
SC295441261QD0000X
SCCBP005261QM1300X
SCFQC102261QM2500X, 261QF0400X
261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC102Medicaid
SCFQC102Medicaid