| Ribaut Medical Partners, Llc | |
|
1094 Ribaut Rd Beaufort SC 29902-5437 | |
| (843) 524-2001 | |
| Not Available |
| Full Name | Ribaut Medical Partners, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1094 Ribaut Rd, Beaufort, South Carolina |
| Authorized Official Name and Position | Samuel Clark Trask (OWNER) |
| Authorized Official Contact | 8435242001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ribaut Medical Partners, Llc Po Box 2329 Beaufort SC 29901-2329 Ph: (843) 524-2001 | Ribaut Medical Partners, Llc 1094 Ribaut Rd Beaufort SC 29902-5437 Ph: (843) 524-2001 |
| NPI Number | 1750800520 |
|---|---|
| Provider Enumeration Date | 09/13/2017 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 4688931686 |
|---|---|
| Medicare Enrollment ID | O20171129002791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750800520 | NPI | - | NPPES |
| 11363059 | Other | CAQH | |
| 22623 | Other | SC | MEDICAL LICENSE |
| 266232 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD22623 (South Carolina) | Primary |
| Provider Name | Samuel C Trask |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730160896 PECOS PAC ID: 9335187699 Enrollment ID: I20050919000582 |
| Provider Name | Paige Amsler Sprietsma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437786639 PECOS PAC ID: 7012347420 Enrollment ID: I20200428000076 |
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