Provider Demographics
NPI:1295859445
Name:SOUTH SUBURBAN NEUROSURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH SUBURBAN NEUROSURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:N
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-331-0998
Mailing Address - Street 1:780 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1622
Mailing Address - Country:US
Mailing Address - Phone:781-331-0250
Mailing Address - Fax:781-340-0506
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1622
Practice Address - Country:US
Practice Address - Phone:781-331-0250
Practice Address - Fax:781-340-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM11250Medicare ID - Type Unspecified