Provider Demographics
NPI:1538275706
Name:BEAUFORT REGIONAL PHYSICIANS, LLC
Entity type:Organization
Organization Name:BEAUFORT REGIONAL PHYSICIANS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-975-4203
Mailing Address - Street 1:740 BRAGAW LANE
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-8415
Mailing Address - Country:US
Mailing Address - Phone:252-946-9562
Mailing Address - Fax:252-946-9071
Practice Address - Street 1:740 BRAGAW LANE
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817-8415
Practice Address - Country:US
Practice Address - Phone:252-946-9562
Practice Address - Fax:252-946-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016A5Medicaid
NC022T3OtherBLUE CROSS BLUE SHIELD
2347896HMedicare PIN