MEDICARE: SHORELINE ASC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0132X	Ophthalmologic Surgery Clinic/Center	61-6816	MI

General Provider Information

NPI Number	:	1285687145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORELINE ASC, LLC

Provider Business Mailing Address
First Line	:	1266 E SHERMAN BLVD
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-1847
Country	:	US
Telephone Number	:	231-737-4710
Fax Number	:	231-737-4711

Provider Business Practice Location Address
First Line	:	1298 E SHERMAN BLVD
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-1831
Country	:	US
Telephone Number	:	231-737-4710
Fax Number	:	231-737-4711

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JOSEPH PRAVOOT GIRA
Credential	:
Telephone Number	:	314-369-3536

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	03/20/2026

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