Basic Information
| Provider Information | |||||||||
| NPI: | 1811937642 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 113 | ||||||||
| Address2: | |||||||||
| City: | SHELDON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299410113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438464188 | ||||||||
| FaxNumber: | 8439870197 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 N OKATIE HWY | ||||||||
| Address2: | |||||||||
| City: | RIDGELAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299368276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439877400 | ||||||||
| FaxNumber: | 8439870197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TOOMER | ||||||||
| AuthorizedOfficialFirstName: | LILLIAN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED NURSE | ||||||||
| AuthorizedOfficialTelephone: | 8439877400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0005X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility |
ID Information
| ID | Type | State | Issuer | Description | R36303 | 01 | SC | REGISTERED NURSE | OTHER |