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
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us