Organization
BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP
Active
Organization
BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP
Active
Other names
Signature Healthcare Brockton Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE C. WALLACE (CEO)
(508) 941-7062
Entity
Organization
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7062
(508) 941-6337
Mailing address
PO BOX 847493, BOSTON, MA 02284-7493
(508) 565-0147
(508) 565-0157
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RR0500X
Rheumatology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208600000X
Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9757350
—
MA
01
—
M19115
BCBS GROUP #
MA
Enumeration date
05/31/2006
Last updated
12/22/2009
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