| Signature Medical Group | |
|
110 Liberty St Brockton MA 02301-5521 | |
| (508) 894-0400 | |
| (508) 565-0157 |
| Full Name | Signature Medical Group |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 110 Liberty St, Brockton, Massachusetts |
| Authorized Official Name and Position | Kim Hollon (CEO) |
| Authorized Official Contact | 5089417004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Signature Medical Group 110 Liberty St Brockton MA 02301-5521 Ph: (508) 894-0400 | Signature Medical Group 110 Liberty St Brockton MA 02301-5521 Ph: (508) 894-0400 |
| NPI Number | 1417932591 |
|---|---|
| Provider Enumeration Date | 12/12/2005 |
| Last Update Date | 06/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417932591 | NPI | - | NPPES |
| 110022141E | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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