Provider Demographics
NPI:1144354820
Name:SHORELINE ENT PLC
Entity type:Organization
Organization Name:SHORELINE ENT PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODCHILD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-777-2625
Mailing Address - Street 1:268 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3733
Mailing Address - Country:US
Mailing Address - Phone:231-777-2625
Mailing Address - Fax:231-773-8560
Practice Address - Street 1:268 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3733
Practice Address - Country:US
Practice Address - Phone:231-777-2625
Practice Address - Fax:231-773-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherEIN