Provider Demographics
NPI:1255707501
Name:SOUTH SHORE HEARING CENTER, LLC
Entity type:Organization
Organization Name:SOUTH SHORE HEARING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:617-794-3988
Mailing Address - Street 1:320 COUNTRY WAY
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-3760
Mailing Address - Country:US
Mailing Address - Phone:617-794-3988
Mailing Address - Fax:
Practice Address - Street 1:541 MAIN ST STE 418
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1845
Practice Address - Country:US
Practice Address - Phone:781-337-6860
Practice Address - Fax:781-337-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA646231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1649220062Medicare NSC