Organization
GOOD SAMARITAN MEDICAL PRACTICE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN J HOLIVER (DIRECTOR)
(617) 562-5482
Entity
Organization
Contact information
Practice address
235 N PEARL ST, GOOD SAMARITAN MEDICAL CENTER, BROCKTON, MA 02301-1794
(617) 562-5482
(617) 562-5415
Mailing address
77 WARREN ST, PROVIDER ENROLLMENT, BRIGHTON, MA 02135-3601
(617) 562-5482
(617) 562-5415
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9779213
—
MA
Enumeration date
10/31/2005
Last updated
08/22/2020
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