Basic Information
| Provider Information | |||||||||
| NPI: | 1053685057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHORE HEALTH SYSTEM SLEEP CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 S. WASHINGTON STREET | ||||||||
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| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108221000 | ||||||||
| FaxNumber: | 4108224958 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 SHOREWAY DR | ||||||||
| Address2: | |||||||||
| City: | QUEENSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216581680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108221000 | ||||||||
| FaxNumber: | 4108224958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2012 | ||||||||
| LastUpdateDate: | 04/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, REVENUE CYCLE OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4108221000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.