Basic Information
| Provider Information | |||||||||
| NPI: | 1508217563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH SHORE PRIMARY AND URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 EAST ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | HANOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023391638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815610460 | ||||||||
| FaxNumber: | 7819878102 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 EAST ST | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | HANOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023391638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815610460 | ||||||||
| FaxNumber: | 7819878102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2016 | ||||||||
| LastUpdateDate: | 06/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | HINCHEY | ||||||||
| AuthorizedOfficialFirstName: | SHERIFAT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7815610460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.