Basic Information
Provider Information | |||||||||
NPI: | 1144599929 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCOTT | ||||||||
FirstName: | ERIN | ||||||||
MiddleName: | ROYAL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 955 RIBAUT RD | ||||||||
Address2: | BMAC CREDENTIALING | ||||||||
City: | BEAUFORT | ||||||||
State: | SC | ||||||||
PostalCode: | 299025441 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8435225674 | ||||||||
FaxNumber: | 8435225678 | ||||||||
Practice Location | |||||||||
Address1: | BEAUFORT MEMORIAL LOWCOUNTRY MEDICAL GROUP | ||||||||
Address2: | 300 MIDTOWN DRIVE | ||||||||
City: | BEAUFORT | ||||||||
State: | SC | ||||||||
PostalCode: | 299065200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8437700404 | ||||||||
FaxNumber: | 8442962308 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/22/2011 | ||||||||
LastUpdateDate: | 07/25/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 17595 | SC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | 17595 | SC | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | NP3364 | 05 | SC |   | MEDICAID |