Provider Demographics
NPI:1700064052
Name:SEASIDE MEDICAL PLC
Entity Type:Organization
Organization Name:SEASIDE MEDICAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STONESTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-710-7180
Mailing Address - Street 1:3379 VAUCLUSE LN
Mailing Address - Street 2:
Mailing Address - City:MACHIPONGO
Mailing Address - State:VA
Mailing Address - Zip Code:23405-2301
Mailing Address - Country:US
Mailing Address - Phone:757-710-7180
Mailing Address - Fax:
Practice Address - Street 1:3379 VAUCLUSE LN
Practice Address - Street 2:
Practice Address - City:MACHIPONGO
Practice Address - State:VA
Practice Address - Zip Code:23405-2301
Practice Address - Country:US
Practice Address - Phone:757-710-7180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment