|
| |
|
111 Torrey St Brockton MA 02301-4800 | |
| (508) 588-1200 | |
| (508) 941-0497 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 111 Torrey St, Brockton, Massachusetts |
| Authorized Official Name and Position | Douglas R Grogan (CEO) |
| Authorized Official Contact | 5085881200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 848889 Boston MA 02284-8889 Ph: (508) 588-1200 | 111 Torrey St Brockton MA 02301-4800 Ph: (508) 588-1200 |
| NPI Number | 1861607558 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 04/04/2016 |
| Medicare PECOS PAC ID | 4688576721 |
|---|---|
| Medicare Enrollment ID | O20040121000327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861607558 | NPI | - | NPPES |
| 9780629 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Douglas R Grogan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962516757 PECOS PAC ID: 2668374711 Enrollment ID: I20050324000853 |
| Provider Name | Susan Sullivan Andrea |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902966039 PECOS PAC ID: 1153354469 Enrollment ID: I20050916000561 |
| Provider Name | Jennifer Hall Difalco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558636373 PECOS PAC ID: 1355594243 Enrollment ID: I20121228000170 |
| Provider Name | Jennifer Karoul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407503865 PECOS PAC ID: 0042650467 Enrollment ID: I20240502002245 |
Healing Hearts Holistically Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 348 North Pearl St, Brockton, MA 02301 Phone: 508-584-3278 Fax: 508-584-3279 | |
Brockton Area Multi-services, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 801 Pleasant St, Brockton, MA 02301 Phone: 508-586-5977 Fax: 508-583-5847 | |
Esp Medical Bilh Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 830 Oak St Ste 102w, Brockton, MA 02301 Phone: 508-521-9259 Fax: 844-823-0453 | |
Freccero Medical Associates Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 77 Byron Ave, Brockton, MA 02301 Phone: 508-583-7595 Fax: 508-559-2278 | |
Tristan Medical Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1340 Belmont St, Brockton, MA 02301 Phone: 508-583-1400 | |
Gis Services 2, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 189 Quincy St, Brockton, MA 02302 Phone: 508-588-6700 Fax: 508-584-3010 |