Provider Demographics
NPI:1720019995
Name:NORTH SHORE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:NORTH SHORE MEDICAL CENTER, INC.
Other - Org Name:NORTH SHORE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF GOVT PROGRAMS, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-436-2267
Mailing Address - Street 1:PO BOX 740926
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0926
Mailing Address - Country:US
Mailing Address - Phone:561-982-2189
Mailing Address - Fax:305-835-6163
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:305-835-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4133282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
009384OtherAVMED
FL010049800Medicaid
445244230OtherAETNA US HEALTHCARE
234OtherBCBS OF FLORIDA
CA0100498-00Medicaid
080093OtherHUMANA
990201OtherNEIGHBORHOOD HEALTH PLAN
100029B000000OtherSECTION 1011
FL010049800Medicaid