Healthcare Provider Details

I. General information

NPI: 1598895542
Provider Name (Legal Business Name): EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 MAIN ST
CHINCOTEAGUE VA
23336-2406
US

IV. Provider business mailing address

20280 MARKET ST
ONANCOCK VA
23417-1331
US

V. Phone/Fax

Practice location:
  • Phone: 757-336-3682
  • Fax: 757-336-3703
Mailing address:
  • Phone: 757-414-0400
  • Fax: 757-414-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JEANNETTE EDWARDS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 757-414-0400