Provider Demographics
NPI:1114097771
Name:SHORE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SHORE HEALTH SERVICES INC
Other - Org Name:SHORE MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:YEARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-8756
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:9507 HOSPITAL AVE
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413
Mailing Address - Country:US
Mailing Address - Phone:757-414-8702
Mailing Address - Fax:757-414-8335
Practice Address - Street 1:9507 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-414-8702
Practice Address - Fax:757-414-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA442205OtherANTHEM
VA4951638Medicaid
VA49U037Medicare ID - Type Unspecified