Provider Demographics
NPI:1427003185
Name:SHORE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:SHORE HEALTH SERVICES, INC
Other - Org Name:RIVERSIDE SHORE MEDICAL CENTER AT METOMPKIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-8000
Mailing Address - Street 1:17385 LANKFORD HWY
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421
Mailing Address - Country:US
Mailing Address - Phone:757-665-5996
Mailing Address - Fax:757-665-5973
Practice Address - Street 1:17385 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-665-5996
Practice Address - Fax:757-665-5973
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7610408Medicaid