Basic Information
| Provider Information | |||||||||
| NPI: | 1083927693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEWARD GOOD SAMARITAN OCCUPATIONAL HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | WHITMAN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023821420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814473083 | ||||||||
| FaxNumber: | 6175627241 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 STOCKWELL DR | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023221170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084273900 | ||||||||
| FaxNumber: | 6175627241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2010 | ||||||||
| LastUpdateDate: | 07/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | RICH | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6177892706 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STEWARD HEALTH CARE SYSTEM LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.