Provider Demographics
NPI:1326288069
Name:SHORE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:SHORE HEALTH SERVICES, INC
Other - Org Name:SHORE GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-8054
Mailing Address - Street 1:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0811
Mailing Address - Country:US
Mailing Address - Phone:757-414-8054
Mailing Address - Fax:
Practice Address - Street 1:9524 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-414-8054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-20
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00228Medicare Oscar/Certification