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Contact Information

BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP
680 CENTRE ST
BROCKTON, MA02302-3308
 Phone: 508-941-7062
 Fax: 508-941-6337
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
 

Endocrinology, Diabetes & Metabolism

207RE0101X 11 Physician/Internal Medicine
 

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
 

Hospitalist

208M00000X
 

Obstetrics & Gynecology

207V00000X 16 Physician/Obstetrics & Gynecology
 

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Pain Medicine

207LP2900X 05 Physician/Anesthesiology
 

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

Rheumatology

207RR0500X 11 Physician/Internal Medicine
 

Surgery

208600000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP

NPI # 1174560304
LBN Legal business name BROCKTON HOSPITAL SPECIALTY PHYSICIAN GROUP
Authorized official EUGENE WALLACE - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 05/31/2006
Last updated 12/22/2009 - About 16 years ago
Identifiers
MA Medicaid 9757350
MA Other M19115 BCBS GROUP #
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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