Healthcare Provider Details

I. General information

NPI: 1285687145
Provider Name (Legal Business Name): SHORELINE ASC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1298 E SHERMAN BLVD
MUSKEGON MI
49444-1831
US

IV. Provider business mailing address

1266 E SHERMAN BLVD
MUSKEGON MI
49444-1847
US

V. Phone/Fax

Practice location:
  • Phone: 231-737-4710
  • Fax: 231-737-4711
Mailing address:
  • Phone: 231-737-4710
  • Fax: 231-737-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number61-6816
License Number StateMI

VIII. Authorized Official

Name: MR. CHRISTOPHER GREK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 231-737-4710