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General NPI Number Information
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NPI Number | 1386823573
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Entity Type | Organization
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Legal Business Name | SHORELINE MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 27 FAIR HARBOUR PL
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City | NEW LONDON
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State | CT
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Zip | 06320-4710
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Country | US
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Telephone | 860-437-8800
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Fax | 860-447-9930
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Provider Business Mailing Address
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Address Line | 27 FAIR HARBOUR PL
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City | NEW LONDON
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State | CT
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Zip | 06320-4710
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Country | US
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Telephone | 860-437-8800
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Fax | 860-447-9930
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARREN JAY COURTRIGHT
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Credential | DPM
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Telephone | 860-437-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 41109232001
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License Number State | CT
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