Provider Demographics
NPI:1558632653
Name:SOUTH SHORE HOSPITAL, INC
Entity Type:Organization
Organization Name:SOUTH SHORE HOSPITAL, INC
Other - Org Name:THE BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-624-8203
Mailing Address - Street 1:55 FOGG RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2455
Mailing Address - Country:US
Mailing Address - Phone:781-624-8000
Mailing Address - Fax:
Practice Address - Street 1:101 COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2455
Practice Address - Country:US
Practice Address - Phone:781-624-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7052150001Medicare NSC