Provider Demographics
NPI:1457639148
Name:SHORELINE MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:SHORELINE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-660-3989
Mailing Address - Street 1:452 BROWNS COVE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8164
Mailing Address - Country:US
Mailing Address - Phone:843-645-9191
Mailing Address - Fax:
Practice Address - Street 1:452 BROWNS COVE RD
Practice Address - Street 2:SUITE B
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8164
Practice Address - Country:US
Practice Address - Phone:843-645-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)