Provider Demographics
NPI:1720317100
Name:WEYMOUTH CLUB
Entity Type:Organization
Organization Name:WEYMOUTH CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-682-5885
Mailing Address - Street 1:75 FINNELL DR
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-1110
Mailing Address - Country:US
Mailing Address - Phone:781-337-4600
Mailing Address - Fax:781-331-9155
Practice Address - Street 1:75 FINNELL DR
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-1110
Practice Address - Country:US
Practice Address - Phone:781-337-4600
Practice Address - Fax:781-331-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000002948133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty