Provider Demographics
NPI:1548771249
Name:SHORE HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:SHORE HEALTH SYSTEM, INC
Other - Org Name:SHORE MEDICAL PAVILION AT QUEENSTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-822-1000
Mailing Address - Street 1:125 SHOREWAY DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:QUEENSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21658
Mailing Address - Country:US
Mailing Address - Phone:410-827-3811
Mailing Address - Fax:410-827-3156
Practice Address - Street 1:125 SHOREWAY DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:QUEENSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21658
Practice Address - Country:US
Practice Address - Phone:410-827-3811
Practice Address - Fax:410-827-3156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic