Healthcare Provider Details

I. General information

NPI: 1275579765
Provider Name (Legal Business Name): SHORELINE ORTHOPAEDIC & SPORTS MEDICINE CLINIC,PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 120TH AVE
HOLLAND MI
49424-2196
US

IV. Provider business mailing address

370 N 120TH AVE
HOLLAND MI
49424-2120
US

V. Phone/Fax

Practice location:
  • Phone: 616-396-5855
  • Fax: 616-396-5720
Mailing address:
  • Phone: 616-396-5855
  • Fax: 616-396-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRICIA SCHILDHOUSE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 616-396-5855