Provider Demographics
NPI:1992141717
Name:SHORELINE IMAGING
Entity type:Organization
Organization Name:SHORELINE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:SCHUMAL
Authorized Official - Suffix:
Authorized Official - Credentials:RT(S)(VS)
Authorized Official - Phone:843-251-5983
Mailing Address - Street 1:PO BOX 16103
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29587-6103
Mailing Address - Country:US
Mailing Address - Phone:843-251-5983
Mailing Address - Fax:
Practice Address - Street 1:910 GYPSY LN
Practice Address - Street 2:
Practice Address - City:MC CLELLANVILLE
Practice Address - State:SC
Practice Address - Zip Code:29458-9733
Practice Address - Country:US
Practice Address - Phone:843-251-5983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC447384335V00000X
SC40231335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier