Healthcare Provider Details

I. General information

NPI: 1972153724
Provider Name (Legal Business Name): SHORELINE HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 US HIGHWAY 17 STE C
HAMPSTEAD NC
28443-6302
US

IV. Provider business mailing address

16150 US HIGHWAY 17 STE C
HAMPSTEAD NC
28443-6302
US

V. Phone/Fax

Practice location:
  • Phone: 910-319-9954
  • Fax: 910-319-9955
Mailing address:
  • Phone: 910-319-9954
  • Fax: 910-319-9955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID FLOYD HOAG II
Title or Position: PRESIDENT
Credential: PA-C
Phone: 910-319-9954