Provider Demographics
NPI:1922383124
Name:SHORES MEDICAL COMPRESSION AND ORTHOTICS, LLC
Entity Type:Organization
Organization Name:SHORES MEDICAL COMPRESSION AND ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:978-922-1700
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 106D
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-922-1700
Mailing Address - Fax:978-922-7662
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 106D
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-922-1700
Practice Address - Fax:978-922-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAC36247332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies