Bridgewater Goddard Park Medical Associates Podiatry Division

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

1715 Issued in MA

Legal business name

BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES PODIATRY DIVISION

Practice address

110 Liberty St
Brockton, MA 02301-5521

Phone

(508) 894-0400

Fax

(508) 565-0157

NPI assigned

Dec 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kim Hollon

Title

Ceo

Phone

(508) 941-7004

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Signature Medical Group Doing business as

Tax ID family

Bridgewater Goddard Park Medical Associates Inc Optometry Division2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bridgewater Goddard Park Medical Associates, Inc Optometry Division

  • Optometrist
  • Brockton, MA
  • NPI 1316121775
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337731200000",
    "number": "1962686329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LIBERTY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015521",
            "telephone_number": "508-894-0400",
            "fax_number": "508-565-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LIBERTY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023015521",
            "telephone_number": "508-894-0400",
            "fax_number": "508-565-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES PODIATRY DIVISION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2012-05-23",
        "status": "A",
        "authorized_official_last_name": "HOLLON",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "508-941-7004",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "MA",
            "license": "1715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110022141E",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Signature Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paleisa Yardley Brice
• Salome L Briceno, MSW LCSW
• George Hamilton Brickhouse Jr., BA
• Tykia D Briddell, LPN
• Taylor Nicole Bridges
• Bridgewater Goddard Park Medical Associates, Inc Optometry Division
• Bridgewater Goddard Park Medical Associates, Inc.
• Bridging Pieces
• Steven Scott Brien, RPH.
• John Edward Briggs Jr.

• Foot Surgery Podiatrist in Brockton, MA
• Providers in Brockton, MA by specialty
• Foot Surgery Podiatrist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.