=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437108222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIELDS IMAGING OF EASTERN MASSACHUSETTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 FOGG RD SOUTH SHORE HOSPITAL CAMPUS
-----------------------------------------------------
City | SOUTH WEYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02190-2432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-897-3271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 CONGRESS ST STE 204
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02169-0928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | KRISTEN DELMORE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-376-7400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | 4416
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------