Provider Demographics
NPI:1376008052
Name:SHORELINE IMAGING CENTER
Entity Type:Organization
Organization Name:SHORELINE IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUMAL
Authorized Official - Suffix:
Authorized Official - Credentials:RT(S)(VS)(ARRT)
Authorized Official - Phone:843-251-5983
Mailing Address - Street 1:9261 HIGHWAY 707 STE F
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7822
Mailing Address - Country:US
Mailing Address - Phone:843-251-5983
Mailing Address - Fax:843-408-4636
Practice Address - Street 1:9261 HIGHWAY 707 STE F
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7822
Practice Address - Country:US
Practice Address - Phone:843-251-5983
Practice Address - Fax:843-408-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty