Basic Information
Provider Information | |||||||||
NPI: | 1932412269 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | STEWARD GOOD SAMARITAN MEDICAL CENTER, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | STEWARD HOME MEDICAL EQUIPMENT - GOOD SAMARITAN HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 235 N PEARL ST | ||||||||
Address2: |   | ||||||||
City: | BROCKTON | ||||||||
State: | MA | ||||||||
PostalCode: | 023011794 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5084272831 | ||||||||
FaxNumber: | 6175627241 | ||||||||
Practice Location | |||||||||
Address1: | 907 SUMNER ST | ||||||||
Address2: | SUITE 205 | ||||||||
City: | STOUGHTON | ||||||||
State: | MA | ||||||||
PostalCode: | 020723374 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7813411918 | ||||||||
FaxNumber: | 8667407533 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/15/2010 | ||||||||
LastUpdateDate: | 07/15/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RICH | ||||||||
AuthorizedOfficialFirstName: | MARK | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
AuthorizedOfficialTelephone: | 6177892706 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | STEWARD HEALTH CARE SYSTEM LLC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.