1619969540 NPI number — SOUTHFIELD REHABILITATION COMPANY

Table of content: (NPI 1619969540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619969540 NPI number — SOUTHFIELD REHABILITATION COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHFIELD REHABILITATION COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SURGEONS CHOICE MACOMB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619969540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/04/2008
NPI Reactivation Date:
09/08/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22401 FOSTER WINTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-423-5100
Provider Business Mailing Address Fax Number:
248-423-5199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11012 THIRTEEN MILE ROAD
Provider Second Line Business Practice Location Address:
SUITE 112A
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-751-9800
Provider Business Practice Location Address Fax Number:
586-751-9818
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SELEY
Authorized Official First Name:
RONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL STAFF COORDINATOR
Authorized Official Telephone Number:
248-423-5198

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  506840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: 506840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 506840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X , with the licence number: 506840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 506840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 506840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: 506840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 029594 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1031384 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 38230 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 135598502 . This is a "U.S. DEPARTMENT OF LABOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4483448 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40003 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40003 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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