Provider Demographics
NPI:1508397381
Name:SHORELINE MEDICAL SOLUTIONS & DME, LLC
Entity Type:Organization
Organization Name:SHORELINE MEDICAL SOLUTIONS & DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENYSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRONG
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:850-215-7212
Mailing Address - Street 1:405 W OAK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2737
Mailing Address - Country:US
Mailing Address - Phone:850-215-7212
Mailing Address - Fax:850-785-3661
Practice Address - Street 1:405 W OAK AVE STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-215-7212
Practice Address - Fax:850-785-3661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1973332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9379OtherBC/BS
FL025923300Medicaid
FL4648040001Medicare NSC