Provider Demographics
NPI:1275655409
Name:SOUTH SHORE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:SOUTH SHORE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-682-5900
Mailing Address - Street 1:90 LIBBEY INDUSTRIAL PARK
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189
Mailing Address - Country:US
Mailing Address - Phone:781-682-5900
Mailing Address - Fax:781-331-1763
Practice Address - Street 1:75 WASHNGTON STREET
Practice Address - Street 2:SOUTH SHORE MEDICAL CENTER, INC
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-9147
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56939207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3014355Medicaid
4278730OtherAETNA
J05903OtherBCBSMA
0013284OtherNEIGHBORHOOD HEALTH PLAN
32150OtherFALLON
171340OtherHARVARD PILGRIM
729421OtherTUFTS & TUFTS MEDICARE PREFERRED
B20290601OtherCIGNA
171340OtherHARVARD PILGRIM
=========OtherHCVM/FIRST HEALTH/COVENTRY
729421OtherTUFTS & TUFTS MEDICARE PREFERRED
=========OtherTRICARE
32150OtherFALLON
=========OtherGREAT WEST HEALTH CARE
=========OtherHCVM/FIRST HEALTH/COVENTRY
=========OtherTRICARE