# BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Signature Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417932591
- **Authorized official:** MR. KIM HOLLON (CEO)
- **Authorized official phone:** (508) 941-7004

## Contact information

- **Practice address:** 110 LIBERTY ST, BROCKTON, MA 02301-5521
- **Practice address phone:** (508) 894-0400
- **Practice address fax:** (508) 565-0157
- **Mailing address:** 110 LIBERTY ST, BROCKTON, MA 02301-5521
- **Mailing address phone:** (508) 894-0400
- **Mailing address fax:** (508) 565-0157

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/12/2005
- **Last updated:** 06/18/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 110022141E | — | MA |