Provider Demographics
NPI:1598413585
Name:EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Entity Type:Organization
Organization Name:EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Other - Org Name:NORTHAMPTON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-0400
Mailing Address - Street 1:20280 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-1331
Mailing Address - Country:US
Mailing Address - Phone:757-414-0400
Mailing Address - Fax:757-414-0569
Practice Address - Street 1:16041 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:EASTVILLE
Practice Address - State:VA
Practice Address - Zip Code:23347
Practice Address - Country:US
Practice Address - Phone:757-678-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)