Healthcare Provider Details

I. General information

NPI: 1952443244
Provider Name (Legal Business Name): EMERALD PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W MAIN ST
HYANNIS MA
02601
US

IV. Provider business mailing address

297 NORTH ST STE 221
HYANNIS MA
02601-5133
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-4777
  • Fax: 508-771-9555
Mailing address:
  • Phone: 508-862-7777
  • Fax: 508-862-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L CONNORS
Title or Position: CFO
Credential:
Phone: 508-957-8540