Provider Demographics
NPI:1619969540
Name:SOUTHFIELD REHABILITATION COMPANY
Entity Type:Organization
Organization Name:SOUTHFIELD REHABILITATION COMPANY
Other - Org Name:SURGEONS CHOICE MACOMB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL STAFF COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-423-5198
Mailing Address - Street 1:22401 FOSTER WINTER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3724
Mailing Address - Country:US
Mailing Address - Phone:248-423-5100
Mailing Address - Fax:248-423-5199
Practice Address - Street 1:11012 THIRTEEN MILE ROAD
Practice Address - Street 2:SUITE 112A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2546
Practice Address - Country:US
Practice Address - Phone:586-751-9800
Practice Address - Fax:586-751-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2023-02-17
Deactivation Date:2008-06-04
Deactivation Code:
Reactivation Date:2008-09-08
Provider Licenses
StateLicense IDTaxonomies
MI506840207X00000X, 207XS0106X, 207XX0005X, 2082S0105X, 2084N0400X, 261QA1903X, 367500000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI029594OtherMIDWEST HEALTH PLAN
MI1031384OtherMCLAREN HEALTH PLAN
MI38230OtherHEALTH PLAN OF MICHIGAN
MI135598502OtherU.S. DEPARTMENT OF LABOR
MI4483448OtherAETNA
MI40003OtherBCBS OF MICHIGAN
MI40003OtherBCBS OF MI
MI4483448OtherAETNA
MI230301Medicare Oscar/Certification
MI4483448OtherAETNA