Provider Demographics
NPI:1447459748
Name:EASTERN SHORE HEALTH CENTER, LLC
Entity type:Organization
Organization Name:EASTERN SHORE HEALTH CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORMOEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-990-2292
Mailing Address - Street 1:908 PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2952
Mailing Address - Country:US
Mailing Address - Phone:251-990-2292
Mailing Address - Fax:251-990-2293
Practice Address - Street 1:908 PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2952
Practice Address - Country:US
Practice Address - Phone:251-990-2292
Practice Address - Fax:251-990-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
AL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-95646OtherBCBS
AL11454869OtherUNITED HEALTH CARE
1266173OtherAHCCS
AL000095646Medicaid
AL1356309496OtherNPI FOR DR. SUZANNETORMOE
AL1356309496OtherNPI FOR DR. SUZANNETORMOE
AL11454869OtherUNITED HEALTH CARE