MEDICARE: MASS GENERAL BRIGHAM AMBULATORY SURGERY WEYMOUTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1679420079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASS GENERAL BRIGHAM AMBULATORY SURGERY WEYMOUTH, LLC

Provider Business Mailing Address
First Line	:	1550 W MCEWEN DR STE 350
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-1792
Country	:	US
Telephone Number	:	615-656-0918
Fax Number	:

Provider Business Practice Location Address
First Line	:	659 WASHINGTON ST STE 2
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-5780
Country	:	US
Telephone Number	:	615-656-0918
Fax Number	:

Authorized Official
Title or Position	:	MANAGER, LICENSING
Name	:	STEPHANIE MARTIN
Credential	:
Telephone Number	:	817-343-2859

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/23/2026

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