Provider Demographics
NPI:1427175108
Name:R. BAUER VAUGHTERS, III, MD, INC.
Entity type:Organization
Organization Name:R. BAUER VAUGHTERS, III, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEEDEE
Authorized Official - Middle Name:HARDEE
Authorized Official - Last Name:VAUGHTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-648-3130
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29802-1132
Mailing Address - Country:US
Mailing Address - Phone:803-648-3130
Mailing Address - Fax:803-648-9860
Practice Address - Street 1:526 RICHLAND AVE W
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3828
Practice Address - Country:US
Practice Address - Phone:803-648-3130
Practice Address - Fax:803-648-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22809174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC228097Medicaid
SCH14116Medicare UPIN