Provider Demographics
NPI:1104005065
Name:SHORELINE NEUROSURGICAL CONSULTING, PLC
Entity Type:Organization
Organization Name:SHORELINE NEUROSURGICAL CONSULTING, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-4243
Mailing Address - Street 1:1675 LEAHY ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442
Mailing Address - Country:US
Mailing Address - Phone:231-728-4243
Mailing Address - Fax:231-722-5074
Practice Address - Street 1:1675 LEAHY ST.
Practice Address - Street 2:SUITE 401
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-728-4243
Practice Address - Fax:231-722-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty