Healthcare Provider Details

I. General information

NPI: 1174945489
Provider Name (Legal Business Name): SHORE TRANSPORT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 LEE MONT RD.
PARKSLEY VA
23421
US

IV. Provider business mailing address

24076 LEE MONT RD.
PARKSLEY VA
23421
US

V. Phone/Fax

Practice location:
  • Phone: 757-665-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. FREDERICK MATTHEWS
Title or Position: CEO
Credential:
Phone: 757-665-1122