Organization
EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED
Active
Other names
Pungoteague Elementary School Dental Program
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNETTE EDWARDS (CHIEF EXECUTIVE OFFICER)
(757) 414-0400
Entity
Organization
Contact information
Practice address
28480 BOBTOWN RD, MELFA, VA 23410-3508
(757) 789-7777
(757) 789-7778
Mailing address
20280 MARKET ST, ONANCOCK, VA 23417-1331
(757) 414-0400
(757) 414-0569
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008450552
—
VA
Enumeration date
10/30/2008
Last updated
03/22/2023
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