SIGNATURE MEDICAL GROUP
NPI 1417932591
Clinic/Center - Multi-Specialty in Brockton, MA

Q: What is Bridgewater Goddard Park Medical Associates, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Active since December 12, 2005CLIA 22D1011221 · Waiver

110 LIBERTY ST, BROCKTON, MA 02301(508) 894-0400(508) 565-0157 Get Directions Write a Review

NPPES record last updated: June 18, 2013. Verified against the NPPES registry weekly; last sync: November 08, 2026.

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About Signature Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SIGNATURE MEDICAL GROUP (NPI 1417932591) is a healthcare organization registered as a multi-specialty in Brockton, Massachusetts and active in the NPI registry since December 2005. The organization holds a CLIA Waiver certificate valid through July 14, 2028 and lists Kim Hollon, Ceo, as its authorized official.

NPPES Registry Identity

NPI1417932591

Entity TypeOrganization

Primary Taxonomy261QM1300X

Legal Business NameBRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES, INC.

Location Address110 LIBERTY STBrockton, MA 02301-5521

Mailing Address110 Liberty StBrockton, MA 02301-5521 · (508) 894-0400 · Fax (508) 565-0157

Phone(508) 894-0400

Fax(508) 565-0157

Organization SubpartNo

Authorized OfficialKim HollonCeo · (508) 941-7004

Enumeration DateDecember 12, 2005

Last NPPES UpdateJune 18, 2013

✔ NPI 1417932591 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities

Taxonomy Code261QM1300X

110 LIBERTY ST, Brockton, MA 02301

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Other Names 1

Doing Business AsSignature Medical Group

Other Identifiers 3

Medicare PINM20452MA

Medicaid110022141EMA

Medicare NSC4423010001MA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 22D1011221

Signature Medical Group · North Easton, MA

Active · expires Jul 14, 2028

CLIA Number22D1011221

Laboratory TypePhysician Office

Certificate Effective DateJuly 15, 2026

Certificate Expiration DateJuly 14, 2028

Laboratory DirectorJames Roan

Laboratory Phone(508) 894-0400

Laboratory LocationSignature Medical Group31 Roche Brothers Way, Suite 130, North Easton, MA 02356

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. RICHARD DUONG PA-C

Physician Assistant