1306958657 NPI number — SOUTH SHORE PULMONARY, 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 1306958657 NPI number — SOUTH SHORE PULMONARY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SHORE PULMONARY, 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:
1306958657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 FORBES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02186-4211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-698-1044
Provider Business Mailing Address Fax Number:
617-773-2193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CONGRESS ST
Provider Second Line Business Practice Location Address:
SUITE 2F
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02169-0908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-698-1044
Provider Business Practice Location Address Fax Number:
617-773-2193
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TARPY
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-698-1044

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9717218 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com