Provider Demographics
NPI:1114160553
Name:SEASHORE POINT - DEACONESS INC
Entity Type:Organization
Organization Name:SEASHORE POINT - DEACONESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLARUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-487-7090
Mailing Address - Street 1:100 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1456
Mailing Address - Country:US
Mailing Address - Phone:508-487-7090
Mailing Address - Fax:
Practice Address - Street 1:100 ALDEN ST
Practice Address - Street 2:
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1456
Practice Address - Country:US
Practice Address - Phone:508-487-7090
Practice Address - Fax:508-487-7706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ENGLAND DEACONESS ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0849261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
225637Medicare PIN