Basic Information
| Provider Information | |||||||||
| NPI: | 1922516053 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEWARD GOOD SAMARITAN MEDICAL CENTER, INC. | ||||||||
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| OtherOrganizationName: | GOOD SAMARITAN HOSPITAL BEHAVIORAL MEDICINE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 PERWAL ST | ||||||||
| Address2: | |||||||||
| City: | WESTWOOD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020901928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813753308 | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 N PEARL ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023011794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084272841 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2018 | ||||||||
| LastUpdateDate: | 01/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | WYMAN | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CORP DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 7813753308 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STEWARD HEALTH CARE SYSTEM LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 282N00000X | 2311 | MA | Y | Hospitals | General Acute Care Hospital |
No ID Information.