Provider Demographics
NPI:1134227606
Name:SOUTH SHORE HOSPITAL INC.
Entity type:Organization
Organization Name:SOUTH SHORE HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-340-8000
Mailing Address - Street 1:55 FOGG ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190
Mailing Address - Country:US
Mailing Address - Phone:781-340-8000
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-340-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2107282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
2222010010OtherBLUE CROSS BLUE SHIELD
900115OtherTUFTS HEALTH PLAN
000000020047OtherBOSTON MEDICAL CENTER HEA
2222010001OtherBLUE CROSS BLUE SHIELD
902226OtherTUFTS HEALTH PLAN
2222010030OtherBLUE CROSS BLUE SHIELD
90015OtherHARVARD PILGRIM HEALTH CA
MA1201662Medicaid
50097059OtherBLUE CROSS BLUE SHIELD
MA1001426Medicaid
220100Medicare ID - Type Unspecified