Organization
EMERALD PHYSICIAN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL L CONNORS (CFO)
(508) 957-8540
Entity
Organization
Contact information
Practice address
433 W MAIN ST, HYANNIS, MA 02601
(508) 778-4777
(508) 771-9555
Mailing address
297 NORTH ST STE 221, HYANNIS, MA 02601-5133
(508) 862-7777
(508) 862-7496
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
208M00000X
Hospitalist Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2520242
AETNA GROUP NUMBER
MA
01
—
685025
USFHP GROUP NUMBER
MA
05
—
9787208
—
MA
01
—
CH1554
RR MEDICARE GROUP NUMBER
—
01
—
M16587
BLUE CROSS GROUP NUMBER
MA
Enumeration date
02/13/2007
Last updated
08/08/2018
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