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Organization
BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC.
Active
Organization
BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC.
Active
Other names
Signature Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIM HOLLON (CEO)
(508) 941-7004
Entity
Organization
Contact information
Practice address
110 LIBERTY ST, BROCKTON, MA 02301-5521
(508) 894-0400
(508) 565-0157
Mailing address
110 LIBERTY ST, BROCKTON, MA 02301-5521
(508) 894-0400
(508) 565-0157
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110022141E
—
MA
Enumeration date
12/12/2005
Last updated
06/18/2013
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