Provider Demographics
NPI:1609990308
Name:SHORE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:SHORE HEALTH SERVICES, INC
Other - Org Name:RIVERSIDE SHORE SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-8054
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0979
Mailing Address - Country:US
Mailing Address - Phone:757-414-8490
Mailing Address - Fax:
Practice Address - Street 1:10111 ROGERS DRIVE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-414-8490
Practice Address - Fax:757-414-8560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05277Medicare Oscar/Certification