Provider Demographics
NPI:1053582031
Name:PLYMOUTH BAY ORTHOPEDIC ASSOCIATES INC.
Entity type:Organization
Organization Name:PLYMOUTH BAY ORTHOPEDIC ASSOCIATES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-934-2400
Mailing Address - Street 1:95 TREMONT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4738
Mailing Address - Country:US
Mailing Address - Phone:781-934-2400
Mailing Address - Fax:781-934-8112
Practice Address - Street 1:95 TREMONT ST
Practice Address - Street 2:SUITE 20
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4738
Practice Address - Country:US
Practice Address - Phone:781-934-7292
Practice Address - Fax:781-934-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA259261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0421932OtherCIGNA HEALTHCARE
MAOG0012OtherBLUE SHIELD OF MASS
MA621691OtherHARVARD PILGRIM HEALTHCAR
MA805013OtherTUFTS HEALTH PLAN
MA621691OtherHARVARD PILGRIM HEALTHCAR