BEAUFORT COUNTY MEMORIAL HOSPITAL (NPI# 1174769764) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174769764 |
| Entity Type | Organization |
| Organization Name | BEAUFORT COUNTY MEMORIAL HOSPITAL |
| Other Organization Name | BEAUFORT MEMORIAL RADIATION ONCOLOGY |
| Practice Address |
989 Ribaut Rd Ste 130 Beaufort SC 29902 |
| Mailing Address |
955 Ribaut Rd Bmac Credentialing Beaufort SC 29902-5441 |
| Practice Telephone | 8435227800 |
| Practice Fax Number | 8435227800 |
| Mailing Telephone | 8435225785 |
| Mailing Fax Number | 8435225678 |
| Enumeration Date | 2009-01-02 |
| Last Update Date | 2020-06-04 |
| Authorized Official Name | EDMOND RUSSELL BAXLEY III (CEO) |
| Authorized Official Telephone | 8435225140 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP8977 | 05 |
| Other Name | Type Code |
|---|---|
| BEAUFORT MEMORIAL KEYSERLING CANCER CENTER | Other Name - Individual/Organization |
| Beaufort Memorial Radiation Oncology | Other Name - Individual/Organization |
| Keyserling Cancer Ctr Radiology Oncology | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 122 Okatie Center Blvd N Ste 102, Okatie, SC 299093750 | 8435227800 | |
| 989 Ribaut Rd Ste 130, Beaufort, SC 299025472 | 8435227800 | 8435227800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063024578 | Beaufort County Memorial Hospital | Family Medicine | Beaufort Memorial Preoperative Assessment Clinic, 989 Ribaut Road Suite 370, Beaufort, SC 29902 | 2020-08-18 |
| 1619248317 | Beaufort County Memorial Hospital | Specialist | 990 Ribaut Rd Ste 210, Beaufort, SC 29902-8011 | 2012-01-26 |
| 1235430745 | Beaufort County Memorial Hospital | Internal Medicine | 1716 Ribaut Rd, Port Royal, SC 29935-1927 | 2010-11-15 |
| 1346474996 | Beaufort County Memorial Hospital | Specialist | Beaufort Memorial Surgical Specialists, 989 Ribaut Rd, Ste 360, Beaufort, SC 29902-5427 | 2009-05-12 |
| 1598713117 | Beaufort County Memorial Hospital | Internal Medicine | Beaufort Memorial Primary Care, 989 Ribaut Rd, Ste 260, Beaufort, SC 29902-5499 | 2006-05-05 |
| 1033175344 | Beaufort County Memorial Hospital | Physician Assistant | 1000 Pine Street West, Varnville, SC 29944-0969 | 2006-04-25 |
| 1366436073 | Beaufort County Memorial Hospital | General Acute Care Hospital | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2005-09-08 |
| 1992327845 | Beaufort County Memorial Hospital | Internal Medicine | 4818 Bluffton Pkwy, Bluffton, SC 29910-4602 | 2020-05-14 |
| 1235552746 | Beaufort County Memorial Hospital | Obstetrics & Gynecology | Beaufort Memorial Obstetrics & Gynecology Specialists, 989 Ribaut Rd, Ste 210, Beaufort, SC 29902-5472 | 2014-02-04 |
| 1013224989 | Beaufort County Memorial Hospital | Clinic/Center | 989 Ribaut Rd, Ste. 240, Beaufort, SC 29902-5472 | 2010-09-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BEAUFORT COUNTY MEMORIAL HOSPITAL | 955 Ribaut Rd, Beaufort, SC 29902-5441 |
| Street Address |
989 RIBAUT RD STE 130 |
| City | BEAUFORT |
| State | SC |
| Zip Code | 29902 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063024578 | Beaufort County Memorial Hospital | Family Medicine | Beaufort Memorial Preoperative Assessment Clinic, 989 Ribaut Road Suite 370, Beaufort, SC 29902 | 2020-08-18 |
| 1750992475 | Fayth Polite | Social Worker | 2210 Salem Drive East, Beaufort, SC 29902 | 2020-08-14 |
| 1417509530 | Andrew Grant Miner | Dentist | Naval Hospital Beaufort, 1 Pinckney Blvd., Fpo, AA 29902 | 2019-07-09 |
| 1376029777 | Edward Dela Fuente | Counselor | Coastal Empire Mental Health Center, 1050 Ribaut Road, Beaufort, SC 29902 | 2018-07-18 |
| 1114440419 | Kristin Webb | Registered Nurse | 607 Wilmington Street, Beaufort, SC 29902 | 2017-07-19 |
| 1326582081 | Annemarie Gierling Gault | Nurse Practitioner | Beaufort Memorial Medical Oncology Infusion Center, 989 Ribaut Rd, Ste 103, Beaufort, SC 29902 | 2016-12-14 |
| 1114396579 | Jacquelyn Faith Proulx | Dentist | 1 Pickney Blvd., Naval Hospital Beaufort, Beaufort, SC 29902 | 2015-09-16 |
| 1386028413 | Howard Family Dental - Beaufort, Pllc | Dentist | 35 Robert Smalls Pkwy, Beaufort, SC 29902 | 2015-07-18 |
| 1598018103 | Lisa Marie Johnson | Occupational Therapist | 9555 Ribaut Road, Beaufort Memorial Hospital, Beaufort, SC 29902 | 2012-10-19 |
| 1134497860 | Jeremy Michael Simmons | Pharmacist | 2127 Boundary Street, Suite 19, Beaufort, SC 29902 | 2011-12-08 |
| Find all providers in zip 29902 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659885754 | Providence Physician Practices, LLC | Radiology | 114 Gateway Corporate Blvd Ste 440, Columbia, SC 29203-9785 | 2017-11-28 |
| 1497045058 | Charles Eric Wooten | Radiology | 805 Pamplico Hwy Ste A315, Florence, SC 29505-6056 | 2011-04-15 |
| 1255518734 | Paul Anthony Saconn | Radiology | 122 Okatie Center Blvd N, Okatie, SC 29909-3750 | 2008-01-27 |
| 1508042201 | Newberry Oncology Associates | Radiology | 298 Commerce Dr., Newberry, SC 29108 | 2008-01-14 |
| 1972624484 | James Fyffe Mcnab | Radiology | 1680 Ribaut Raod, Ste A, Port Royal, SC 29935-2029 | 2007-04-02 |
| 1568516383 | Edward William Duffy Jr. | Radiology | 130 North Washington Street, Sumter, SC 29150 | 2007-01-22 |
| 1811908064 | Vipul V Thakkar | Radiology | 228 S Herlong Ave, Rock Hill, SC 29732-1158 | 2006-08-11 |
| 1285645937 | Eduard Dvorak | Radiology | 30494 435th Ave, Utica, SC 57067-5905 | 2006-08-10 |
| 1013947589 | Larry Douglas Grubb | Radiology | 130 N Washington St, Sumter, SC 29150-4920 | 2006-07-03 |
| 1053356493 | Dean Alan Gant | Radiology | 1005 W Meeting St, Lancaster, SC 29720-2205 | 2006-06-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.