Organization
BEAUFORT COUNTY MEMORIAL HOSPITAL
Active
Parent organization
BEAUFORT COUNTY MEMORIAL HOSPITAL
Other names
Beaufort Memorial Surgical Specialist
Organization subpart
Yes
Provider details
NPI number
Legal business name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Authorized official
MR. EDMOND RUSSELL BAXLEY III (CEO)
(843) 522-5140
Entity
Organization
Contact information
Practice address
BEAUFORT MEMORIAL SURGICAL SPECIALISTS, 989 RIBAUT RD, STE 360, BEAUFORT, SC 29902-5427
(843) 524-8171
(844) 296-2307
Mailing address
955 RIBAUT ROAD, BMAC CREDENTIALING COORDINATOR, BEAUFORT, SC 29902-5441
(843) 522-5674
(843) 522-5678
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346474996
BCBSSC
SC
01
—
155666800
US DEPT OF LABOR
SC
01
—
42D0957596
CLIA
SC
05
—
GP8668
—
SC
Enumeration date
05/12/2009
Last updated
10/21/2020
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