Provider Demographics
NPI:1508217563
Name:SOUTH SHORE PRIMARY AND URGENT CARE LLC
Entity Type:Organization
Organization Name:SOUTH SHORE PRIMARY AND URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIFAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HINCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-561-0460
Mailing Address - Street 1:20 EAST ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1638
Mailing Address - Country:US
Mailing Address - Phone:781-561-0460
Mailing Address - Fax:781-987-8102
Practice Address - Street 1:20 EAST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1638
Practice Address - Country:US
Practice Address - Phone:781-561-0460
Practice Address - Fax:781-987-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty