Provider Demographics
NPI:1891201679
Name:PLUSHCARE PHYSICIAN'S GROUP LTD.
Entity Type:Organization
Organization Name:PLUSHCARE PHYSICIAN'S GROUP LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WANTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-731-5677
Mailing Address - Street 1:101 MISSION ST STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-1744
Mailing Address - Country:US
Mailing Address - Phone:415-231-5333
Mailing Address - Fax:415-231-5332
Practice Address - Street 1:801 ADLAI STEVENSON DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4261
Practice Address - Country:US
Practice Address - Phone:415-231-5333
Practice Address - Fax:415-231-5332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLUSHCARE OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-15
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty