Provider Demographics
NPI:1346564697
Name:SHORE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:SHORE HEALTH SERVICES, INC
Other - Org Name:RIVERSIDE SHORE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-8000
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0718
Mailing Address - Country:US
Mailing Address - Phone:757-414-8054
Mailing Address - Fax:757-414-8055
Practice Address - Street 1:9507 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413-0718
Practice Address - Country:US
Practice Address - Phone:757-414-8054
Practice Address - Fax:757-414-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty