Healthcare Provider Details

I. General information

NPI: 1790193522
Provider Name (Legal Business Name): SOUTH COUNTY ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KENYON AVE
WAKEFIELD RI
02879-4216
US

IV. Provider business mailing address

1342 BELMONT ST SUITE 205
BROCKTON MA
02301-4436
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-8000
  • Fax: 401-789-3450
Mailing address:
  • Phone: 508-580-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES FRANCIS GRIFFIN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 401-788-0196