Provider Demographics
| NPI: | 1790785095 |
|---|---|
| Name: | SOUTHFIELD REHABILITATION COMPANY |
| Entity Type: | Organization |
| Organization Name: | SOUTHFIELD REHABILITATION COMPANY |
| Other - Org Name: | SURGEONS CHOICE MEDICAL CENTER |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | RONDA |
| Authorized Official - Middle Name: | F |
| Authorized Official - Last Name: | SELEY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | DO |
| Authorized Official - Phone: | 248-423-5198 |
| 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: | 22401 FOSTER WINTER DRIVE |
| Practice Address - Street 2: | |
| Practice Address - City: | SOUTHFIELD |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 48075-3724 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 248-423-5100 |
| Practice Address - Fax: | 248-423-5199 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-07-28 |
| Last Update Date: | 2019-12-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207XS0106X, 207XX0005X, 2082S0105X, 2084N0400X, 2085R0202X, 2471C3401X, 261QR0208X, 367500000X | ||
| MI | 630013 | 261QA1903X, 282N00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
| No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
| No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
| No | 2082S0105X | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 2471C3401X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography | Group - Multi-Specialty |
| No | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | Group - Multi-Specialty |
| No | 261QR0208X | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile | |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MI | 5968608 | Other | AETNA |
| MI | 30 2837175 | Medicaid | |
| MI | 00127 | Other | BLUE CARE NETWORK |
| 00127 | Other | BCBS OF MICHIGAN | |
| MI | 007389 | Other | MIDWEST HEALTH PLAN |
| MI | 34692 | Other | HEALTH PLAN OF MICHIGAN |
| MI | 1031384 | Other | MCLAREN HEALTH PLAN |
| MI | 40 2837237 | Medicaid | |
| 135598501 | Other | U.S. DEPARTMENT OF LABOR | |
| MI | 40 2837237 | Medicaid | |
| 0P30420 | Medicare Oscar/Certification |
