Provider Demographics
NPI:1427160571
Name:SHORELINE MEDICAL GROUP, P.A.
Entity type:Organization
Organization Name:SHORELINE MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-229-8010
Mailing Address - Street 1:419 BALTZELL AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1864
Mailing Address - Country:US
Mailing Address - Phone:850-229-8010
Mailing Address - Fax:850-227-3177
Practice Address - Street 1:419 BALTZELL AVE
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456
Practice Address - Country:US
Practice Address - Phone:850-229-8010
Practice Address - Fax:850-227-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377827401OtherMEDICAID RHC
10-3887OtherMEDICARE RHC
FL377827400Medicaid
FL377827401OtherMEDICAID RHC