1952405979 NPI number — SCITUATE PODIATRY GROUP INC

Table of content: (NPI 1952405979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952405979 NPI number — SCITUATE PODIATRY GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCITUATE PODIATRY GROUP 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:
1952405979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 NEW DRIFTWAY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SCITUATE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02066-4546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-545-9285
Provider Business Mailing Address Fax Number:
781-545-9553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
541 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-337-3334
Provider Business Practice Location Address Fax Number:
781-331-2197
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COUNT
Authorized Official First Name:
GARY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PROVIDER/OWNER
Authorized Official Telephone Number:
781-545-9285

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  001515 , 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: 9781331 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009377 . This is a "NEIGHBORHOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 606371 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: CG5531 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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