Shore Health Services Inc | NPI 1114097771

Key facts

NPI: 1114097771
Entity type: Organization (NPI type 2)
Primary specialty: Medicare Defined Swing Bed Hospital Unit 275N00000X
Legal business name: SHORE HEALTH SERVICES INC
Practice address: 9507 Hospital Ave
Nassawadox, VA 23413
Phone: (757) 414-8702
Fax: (757) 414-8335
NPI assigned: Nov 9, 2006
Organization subpart: No

Authorized official

Name: Mr. Robert P Yearty
Title: Cfo
Phone: (757) 414-8756

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Medicare Defined Swing Bed Hospital Unit	275N00000X		VA	Yes

Addresses

Primary practice location

9507 Hospital Ave
Nassawadox, VA 23413

Mailing address

PO Box 17
9507 Hospital Ave
Nassawadox, VA 23413
Phone (757) 414-8702

Other identifiers

Identifier	Type	State	Issuer
442205	Other	VA	ANTHEM
4951638	Medicaid	VA

Other names

Shore Memorial Hospital Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1114097771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17",
            "address_2": "9507 HOSPITAL AVE",
            "city": "NASSAWADOX",
            "state": "VA",
            "postal_code": "23413",
            "telephone_number": "757-414-8702",
            "fax_number": "757-414-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9507 HOSPITAL AVE",
            "city": "NASSAWADOX",
            "state": "VA",
            "postal_code": "23413",
            "telephone_number": "757-414-8702",
            "fax_number": "757-414-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORE HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "YEARTY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "757-414-8756",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "442205",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4951638",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shore Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nassawadox, VA

All providers in Nassawadox, VA · Medicare Defined Swing Bed Hospital Unit in Virginia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.