=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699068783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTERN SHORE CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2011
-----------------------------------------------------
Last Update Date | 07/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 N SECTION ST
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-2649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-928-9090
-----------------------------------------------------
Fax | 251-990-0520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2935 THOUSAND OAKS DR STE 294
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78247-3563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-494-1100
-----------------------------------------------------
Fax | 251-929-2500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | DR. WILLIAM R STAGGERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 251-929-7850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------