NPIMap

Organization Active NPI

Beaufort County Memorial Hospital

  • Psychiatry Physician
  • Beaufort, SC
National Provider Identifier
1801035456
Registry record updated Nov 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
BEAUFORT COUNTY MEMORIAL HOSPITAL
Practice address
989 Ribaut Rd
Suite 240
Beaufort, SC 29902-5472
Phone
(843) 522-5600
Fax
(843) 522-7625
NPI assigned
Feb 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Edmond Russell Baxley III
Title
Ceo
Phone
(843) 522-5140

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

989 Ribaut Rd
Suite 240
Beaufort, SC 29902-5472

Mailing address

989 Ribaut Rd
Suite 260
Beaufort, SC 29902-5472
Phone (843) 522-5600

Other identifiers 1

IdentifierTypeStateIssuer
400676MedicaidSC

Other names 1

  • BEAUFORT MEMORIAL SEA ISLAND PSYCHIATRY Other name

National Provider Directory

National Provider Directory
Tax ID family
Sea Island Cancer Center16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572998400000",
    "number": "1801035456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "989 RIBAUT RD",
            "address_2": "SUITE 260",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025472",
            "telephone_number": "843-522-5600",
            "fax_number": "843-522-7625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "989 RIBAUT RD",
            "address_2": "SUITE 240",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299025472",
            "telephone_number": "843-522-5600",
            "fax_number": "843-522-7625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUFORT COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-05",
        "last_updated": "2019-11-06",
        "status": "A",
        "authorized_official_last_name": "BAXLEY",
        "authorized_official_first_name": "EDMOND",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-522-5140",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400676",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEAUFORT MEMORIAL SEA ISLAND PSYCHIATRY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Beaufort, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.