Provider Demographics
NPI:1952443244
Name:EMERALD PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:EMERALD PHYSICIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-957-8540
Mailing Address - Street 1:297 NORTH ST STE 221
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5133
Mailing Address - Country:US
Mailing Address - Phone:508-862-7777
Mailing Address - Fax:508-862-7496
Practice Address - Street 1:433 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-778-4777
Practice Address - Fax:508-771-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA685025OtherUSFHP GROUP NUMBER
MAM16587OtherBLUE CROSS GROUP NUMBER
MA9787208Medicaid
MA685025OtherTUFTS INS. GROUP NUMBER
CH1554OtherRR MEDICARE GROUP NUMBER
MA2520242OtherAETNA GROUP NUMBER
M20740Medicare PIN