1669558474 NPI number — SOUTH SHORE HOSPITAL 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 1669558474 NPI number — SOUTH SHORE HOSPITAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SHORE HOSPITAL 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:
6
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:
1669558474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 RESERVOIR PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLAND
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02370-1055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-617-7891
Provider Business Mailing Address Fax Number:
781-792-4201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BAY STATE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRAINTREE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02184-9060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-849-1710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PASCARELLI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
FINANCE MANAGER
Authorized Official Telephone Number:
781-624-7891

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000021549 . This is a "BOSTON MEDICAL CTR HLTH N" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0605875 . This is a "COMMISSION OF THE BLIND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0605875 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 702005 . This is a "HARVARD PILGRIM HLTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803015 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 120082 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0009286 . This is a "NEIGHBORHOOD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1339 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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