BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES INC. NPI 1417932591

NPI Information

NPI: 1417932591
Provider Name: BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC.

Doing Business As: SIGNATURE MEDICAL GROUP

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
110 LIBERTY ST
BROCKTON, MA
ZIP 02301
Phone: (508) 894-0400
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BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC. is a multi-specialty clinic center in Brockton, MA. BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC. NPI is 1417932591. The provider is registered as an organization entity type.
The provider Is Doing Business As Signature Medical Group.

The provider's business location address is:

110 LIBERTY ST
BROCKTON, MA
ZIP 02301-521
Phone: (508) 894-0400
Fax: (508) 565-0157

The provider's authorized official is Kim Hollon .
The authorized official title is Ceo and has the following contact phone number (508) 941-7004.

The enumeration date for this NPI number is 12/12/2005 and was last updated on 6/18/2013.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	M20452	MEDICARE PIN	MASSACHUSETTS
2	110022141E	MEDICAID	MASSACHUSETTS
3	4423010001	MEDICARE NSC	MASSACHUSETTS

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: 4/28/2024

NPI Synchronization or Removal

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