Provider Demographics
NPI:1720285018
Name:SOUTH SHORE ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:SOUTH SHORE ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-337-5555
Mailing Address - Street 1:2 POND PARK
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:781-335-6047
Practice Address - Street 1:2 POND PARK
Practice Address - Street 2:SUITE 102
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-335-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MA154105207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0003906OtherMEDICARE
MAM19412OtherBLUE CROSS BLUE SHIELD
671125OtherTUFTS HEALTH PLAN
72024OtherNEIGHBORHOOD HEALTH PLAN
MA9792040Medicaid
34684OtherFALLON
MA9792040Medicaid
=========OtherHARVARD PILGRIM HEALTH
MA9792040Medicaid