Healthcare Provider Details

I. General information

NPI: 1649987058
Provider Name (Legal Business Name): EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25228 LANKFORD HIGHWAY
ONLEY VA
23418-2341
US

IV. Provider business mailing address

20280 MARKET ST
ONANCOCK VA
23417-1331
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
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