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NPI Code Detail

MEDICARE: SOUTH COVE COMMUNITY HEALTH CENTER, INC.

MEDICARE: SOUTH COVE COMMUNITY HEALTH CENTER, INC.
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
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1740527175
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH COVE COMMUNITY HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : 145 SOUTH ST
Second Line :
City : BOSTON
State : MA
Zip : 02111-2826
Country : US
Telephone Number : 617-521-6713
Fax Number : 617-521-6799
Provider Business Practice Location Address
First Line : 435 HANCOCK ST
Second Line :
City : QUINCY
State : MA
Zip : 02171-2428
Country : US
Telephone Number : 617-318-3300
Fax Number : 617-318-3399
Authorized Official
Title or Position : CEO
Name : MR. ERIC TIBERI
Credential :
Telephone Number : 617-521-6708
Provider Enumeration Date : 01/04/2013
Last Update Date : 04/06/2026

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