Provider Demographics
NPI:1487154175
Name:PLUSHCARE PHYSICIAN'S GROUP, PC
Entity type:Organization
Organization Name:PLUSHCARE PHYSICIAN'S GROUP, PC
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:415-231-5333
Mailing Address - Street 1:650 5TH ST STE 311
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1542
Mailing Address - Country:US
Mailing Address - Phone:415-231-5333
Mailing Address - Fax:
Practice Address - Street 1:650 5TH ST STE 311
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1542
Practice Address - Country:US
Practice Address - Phone:415-231-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLUSHCARE OF CALIFORNIA INC., A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty