Provider Demographics
NPI:1477722585
Name:SOUTHFIELD REHABILITATION COMPANY
Entity Type:Organization
Organization Name:SOUTHFIELD REHABILITATION COMPANY
Other - Org Name:SURGEONS CHOICE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-423-5111
Mailing Address - Street 1:PO BOX 674073
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4073
Mailing Address - Country:US
Mailing Address - Phone:586-582-0864
Mailing Address - Fax:586-576-0393
Practice Address - Street 1:11012 THIRTEEN MILE ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2546
Practice Address - Country:US
Practice Address - Phone:586-558-8470
Practice Address - Fax:586-558-8481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2019-12-06
Deactivation Date:2008-06-04
Deactivation Code:
Reactivation Date:2008-09-03
Provider Licenses
StateLicense IDTaxonomies
MI43010460612085R0202X
MI50C656261QR0208X
MI630013282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI283723740Medicaid
MI40003OtherBCBS
MI700E021910OtherBCBS OF MICHIGAN
MI135598501OtherU.S. DEPARTMENT OF LABOR
MI032307OtherMIDWEST HEALTH PLAN
MI40003OtherBCBS
MI283723740Medicaid