Basic Information
| Provider Information | |||||||||
| NPI: | 1063024578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEAUFORT COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100169 | ||||||||
| Address2: | CL900003 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435225790 | ||||||||
| FaxNumber: | 8435225945 | ||||||||
| Practice Location | |||||||||
| Address1: | BEAUFORT MEMORIAL PREOPERATIVE ASSESSMENT CLINIC | ||||||||
| Address2: | 989 RIBAUT ROAD SUITE 370 | ||||||||
| City: | BEAUFORT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435225775 | ||||||||
| FaxNumber: | 8435225945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2020 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | SIMMONS | ||||||||
| AuthorizedOfficialFirstName: | TRIMMELL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL STAFF COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8435225790 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEAUFORT COUNTY MEMORIAL HOSPITAL | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.