Provider Demographics
NPI:1831122159
Name:SOUTH SHORE ENDOSCOPY CENTER, INC
Entity Type:Organization
Organization Name:SOUTH SHORE ENDOSCOPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-952-1249
Mailing Address - Street 1:77 ACCORD PARK DR
Mailing Address - Street 2:BLDG D4 - CREDENTIALING
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1623
Mailing Address - Country:US
Mailing Address - Phone:781-952-1526
Mailing Address - Fax:781-878-8627
Practice Address - Street 1:659 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5778
Practice Address - Country:US
Practice Address - Phone:781-849-9577
Practice Address - Fax:781-849-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA221026Medicare PIN