Provider Demographics
NPI:1588690408
Name:LOWCOUNTRY MEDICAL GROUP OF BEAUFORT COUNTY
Entity type:Organization
Organization Name:LOWCOUNTRY MEDICAL GROUP OF BEAUFORT COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-770-0404
Mailing Address - Street 1:1010 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-3447
Mailing Address - Country:US
Mailing Address - Phone:843-784-8305
Mailing Address - Fax:
Practice Address - Street 1:300 MID TOWN DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-5200
Practice Address - Country:US
Practice Address - Phone:843-784-8305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5812Medicare ID - Type Unspecified