Provider Demographics
NPI:1538214010
Name:SOUTH SHORE HEARING CENTER, INC.
Entity type:Organization
Organization Name:SOUTH SHORE HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CITRON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:781-337-6861
Mailing Address - Street 1:541 MAIN STREET
Mailing Address - Street 2:SUITE 418
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190
Mailing Address - Country:US
Mailing Address - Phone:781-337-6861
Mailing Address - Fax:781-337-2103
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 418
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-337-6861
Practice Address - Fax:781-337-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9776788Medicaid
MA9776788Medicaid