EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED NPI 1316694946

NPI Information

NPI: 1316694946
Provider Name: EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED

Doing Business As: OCCOHANNOCK DENTAL

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 49D2082561

Address:
4208 SEASIDE RD
EXMORE, VA
ZIP 23350
Phone: (757) 678-5151
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EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED is a federally qualified health center (fqhc) clinic center in Exmore, VA. EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED NPI is 1316694946. The provider is registered as an organization entity type.
The provider Is Doing Business As Occohannock Dental.

The provider's business location address is:

4208 SEASIDE RD
EXMORE, VA
ZIP 23350-575
Phone: (757) 678-5151

The provider's authorized official is Jeannette Edwards .
The authorized official title is Chief Executive Officer and has the following contact phone number (757) 414-0400.

The CLIA number assigned to this NPI record is 49D2082561 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/3/2022 and was last updated on 3/22/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

What is NPI?

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This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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