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BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP NPI 1174560304


NPI Information

NPI: 1174560304
Provider Name: BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP

Doing Business As: SIGNATURE HEALTHCARE BROCKTON HOSPITAL

Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Address:
680 CENTRE ST
BROCKTON, MA
ZIP 02302
Phone: (508) 941-7062
Get Directions

BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP is an internal medicine in Brockton, MA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP NPI is 1174560304. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Signature Healthcare Brockton Hospital.

The provider's business location address is:

680 CENTRE ST
BROCKTON, MA
ZIP 02302-308
Phone: (508) 941-7062
Fax: (508) 941-6337

The provider's authorized official is Eugene C. Wallace .
The authorized official title is Ceo and has the following contact phone number (508) 941-7062.

The enumeration date for this NPI number is 5/31/2006 and was last updated on 12/22/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207P00000XEmergency MedicineNo
2208M00000XHospitalistNo
3207V00000XObstetrics & GynecologyNo
4207LP2900XAnesthesiologyPain MedicineNo
52084P0800XPsychiatry & NeurologyPsychiatryNo
6208000000XPediatricsNo
7208600000XSurgeryNo
8207RC0000XInternal MedicineCardiovascular DiseaseNo
9207RE0101XInternal MedicineEndocrinology, Diabetes & MetabolismNo
10207RP1001XInternal MedicinePulmonary DiseaseNo
11207RR0500XInternal MedicineRheumatologyNo
121041C0700XSocial WorkerClinicalNo
13207RG0100XInternal MedicineGastroenterologyNo
14207X00000XOrthopaedic SurgeryNo
15207R00000XInternal MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
19757350MEDICAIDMASSACHUSETTS
2M19115OTHERMASSACHUSETTSBCBS GROUP #
3M21752MEDICARE ID-TYPE UNSPECIFIEDMASSACHUSETTSGROUP #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.