1275655409 NPI number — SOUTH SHORE MEDICAL CENTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275655409 NPI number — SOUTH SHORE MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SHORE MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275655409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 LIBBEY INDUSTRIAL PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-682-5900
Provider Business Mailing Address Fax Number:
781-331-1763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 WASHNGTON STREET
Provider Second Line Business Practice Location Address:
SOUTH SHORE MEDICAL CENTER, INC
Provider Business Practice Location Address City Name:
NORWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02061-9147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-878-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BULMAN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
ORTHOPEDIC PHYSICIAN
Authorized Official Telephone Number:
781-682-5900

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  56939 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3014355 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4278730 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J05903 . This is a "BCBSMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0013284 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32150 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171340 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 729421 . This is a "TUFTS & TUFTS MEDICARE PREFERRED" identifier . This identifiers is of the category "OTHER".
  • Identifier: B20290601 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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