Healthcare Provider Details

I. General information

NPI: 1619674512
Provider Name (Legal Business Name): SHORELINE ORTHOPAEDIC & SPORTS MEDICINE CLINIC P L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 KELLY ST
HUDSONVILLE MI
49426-1407
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: 877-592-0688
Mailing address:
  • Phone: 616-396-5855
  • Fax: 877-592-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRICIA SCHILDHOUSE
Title or Position: CEO
Credential: MBA
Phone: 616-396-5855