Provider Demographics
NPI:1881370799
Name:SHORELINE ORTHOPAEDIC & SPORTS MEDICINE CLINIC P L C
Entity type:Organization
Organization Name:SHORELINE ORTHOPAEDIC & SPORTS MEDICINE CLINIC P L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHILDHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-396-5855
Mailing Address - Street 1:370 120TH AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2196
Mailing Address - Country:US
Mailing Address - Phone:616-396-5855
Mailing Address - Fax:877-592-0688
Practice Address - Street 1:8251 WESTPARK WAY
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464
Practice Address - Country:US
Practice Address - Phone:616-396-5855
Practice Address - Fax:877-592-0688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORELINE ORTHOPAEDIC & SPORTS MEDICINE CLINIC P L C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-26
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty