Healthcare Provider Details

I. General information

NPI: 1548543515
Provider Name (Legal Business Name): SRS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HANCOCK ST SUITE 1
QUINCY MA
02171-2249
US

IV. Provider business mailing address

275 HANCOCK ST SUITE 1
QUINCY MA
02171-2249
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-7777
  • Fax:
Mailing address:
  • Phone: 617-471-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY TRUEX
Title or Position: CPO
Credential: DC
Phone: 617-471-7777