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General NPI Number Information
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NPI Number | 1285687145
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Entity Type | Organization
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Legal Business Name | SHORELINE ASC, INC.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1298 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1831
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Country | US
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Telephone | 231-737-4710
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Fax | 231-737-4711
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Provider Business Mailing Address
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Address Line | 1266 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1847
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Country | US
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Telephone | 231-737-4710
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Fax | 231-737-4711
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CHRISTOPHER GREK
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Credential |
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Telephone | 231-737-4710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 61-6816
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License Number State | MI
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