Provider Demographics
NPI:1962769190
Name:SOUTH SHORE UROLOGY, INC.
Entity type:Organization
Organization Name:SOUTH SHORE UROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HELFRICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:781-331-4600
Mailing Address - Street 1:780 MAIN ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1639
Mailing Address - Country:US
Mailing Address - Phone:781-331-4600
Mailing Address - Fax:781-337-5095
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1639
Practice Address - Country:US
Practice Address - Phone:781-331-4600
Practice Address - Fax:781-337-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5694099OtherCOVENTRY/FIRST HEALTH
600135OtherTUFTS
M13172OtherBLUE CROSS BLUE SHIELD
36004OtherFALLON
MA9718672Medicaid
M13172OtherBLUE CROSS BLUE SHIELD