Shoreline Medical Supply, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

41109232001 Issued in CT

Legal business name

SHORELINE MEDICAL SUPPLY, LLC

Practice address

27 Fair Harbour PL
New London, CT 06320-4710

Phone

(860) 437-8800

Fax

(860) 447-9930

NPI assigned

Oct 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Darren Jay Courtright, DPM

Title

President

Phone

(860) 437-8800

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1386823573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 FAIR HARBOUR PL",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204710",
            "telephone_number": "860-437-8800",
            "fax_number": "860-447-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 FAIR HARBOUR PL",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204710",
            "telephone_number": "860-437-8800",
            "fax_number": "860-447-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE MEDICAL SUPPLY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "COURTRIGHT",
        "authorized_official_first_name": "DARREN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-437-8800",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "41109232001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in New London, CT
• Providers in New London, CT by specialty
• Durable Medical Equipment & Medical Supplies in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.