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General NPI Number Information
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NPI Number | 1083927693
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Entity Type | Organization
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Legal Business Name | STEWARD GOOD SAMARITAN OCCUPATIONAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 75 STOCKWELL DR
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City | AVON
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State | MA
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Zip | 02322-1170
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Country | US
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Telephone | 508-427-3900
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Fax | 617-562-7241
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Provider Business Mailing Address
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Address Line | 112 PARK AVE
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City | WHITMAN
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State | MA
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Zip | 02382-1420
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Country | US
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Telephone | 781-447-3083
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Fax | 617-562-7241
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MARK J RICH
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Credential |
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Telephone | 617-789-2706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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