Provider Demographics
NPI:1285687145
Name:SHORELINE ASC, INC.
Entity type:Organization
Organization Name:SHORELINE ASC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-737-4710
Mailing Address - Street 1:1266 E SHERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1847
Mailing Address - Country:US
Mailing Address - Phone:231-737-4710
Mailing Address - Fax:231-737-4711
Practice Address - Street 1:1298 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1831
Practice Address - Country:US
Practice Address - Phone:231-737-4710
Practice Address - Fax:231-737-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI61-6816261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery