Provider Demographics
NPI:1245394576
Name:HAND & PLASTIC SURGERY CENTRE PLC
Entity Type:Organization
Organization Name:HAND & PLASTIC SURGERY CENTRE PLC
Other - Org Name:ELITE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN-STOUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-459-4131
Mailing Address - Street 1:245 CHERRY ST SE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4607
Mailing Address - Country:US
Mailing Address - Phone:616-459-4131
Mailing Address - Fax:616-459-6030
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:SUITE 302
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-459-4131
Practice Address - Fax:616-459-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4273703Medicaid
MI4694901Medicaid
MI0D16253OtherBCBS OF MICHIGAN
MI2727404Medicaid
MI4488298Medicaid
MI3323257Medicaid
MI4075832Medicaid
MI1518916535Medicare UPIN
MI4488298Medicaid
MI4273703Medicaid
MI3323257Medicaid
MI1558310912Medicare UPIN
MIOD16253012Medicare ID - Type UnspecifiedWILLIAM T CULLEN MD
MI4694901Medicaid
MI1750330650Medicare UPIN
MI1225087679Medicare UPIN
MIOD16253006Medicare ID - Type UnspecifiedRONALD D FORD MD
MI2727404Medicaid
MI1336192764Medicare UPIN
MI1689624017Medicare UPIN