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
—
—
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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