MEDICARE: EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1174502967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED.

Provider Business Mailing Address
First Line	:	20280 MARKET ST
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-1331
Country	:	US
Telephone Number	:	757-414-0400
Fax Number	:	757-414-0569

Provider Business Practice Location Address
First Line	:	20280 MARKET ST
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-1331
Country	:	US
Telephone Number	:	757-414-0400
Fax Number	:	757-414-0569

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JEANNETTE EDWARDS
Credential	:
Telephone Number	:	757-414-0400

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	03/22/2023

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