Signature Medical Group | |
110 Liberty St Brockton MA 02301-5521 | |
(508) 894-0400 | |
(508) 565-0157 |
Full Name | Signature Medical Group |
---|---|
Speciality | Clinic/center - Multi-specialty |
Location | 110 Liberty St, Brockton, Massachusetts |
Authorized Official Name and Position | Kim Hollon (CEO) |
Authorized Official Contact | 5089417004 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Signature Medical Group 110 Liberty St Brockton MA 02301-5521 Ph: (508) 894-0400 | Signature Medical Group 110 Liberty St Brockton MA 02301-5521 Ph: (508) 894-0400 |
NPI Number | 1417932591 |
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Provider Enumeration Date | 12/12/2005 |
Last Update Date | 06/18/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417932591 | NPI | - | NPPES |
110022141E | Medicaid | MA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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