MEDICARE: SOUTHCOAST PHYSICIANS GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207Q00000X	Family Medicine Physician	MA
2	207R00000X	Internal Medicine Physician	MA
3	208000000X	Pediatrics Physician	MA
4	208M00000X	Hospitalist Physician	MA
5	207P00000X	Emergency Medicine Physician	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	M20518	OTHER	MA	MEDICARE
3	CD2506	OTHER	MA	RAILROAD MEDICARE
4	709004034	OTHER	RI	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700393808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHCOAST PHYSICIANS GROUP, INC.

Provider Business Mailing Address
First Line	:	200 MILL RD STE 180
Second Line	:
City	:	FAIRHAVEN
State	:	MA
Zip	:	02719-5255
Country	:	US
Telephone Number	:	508-973-2000
Fax Number	:	508-973-2001

Provider Business Practice Location Address
First Line	:	12 MAIN ST
Second Line	:
City	:	LAKEVILLE
State	:	MA
Zip	:	02347-1606
Country	:	US
Telephone Number	:	508-973-2432
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, MEDICAL STAFF SVCS
Name	:	KIMBERLEY COON
Credential	:
Telephone Number	:	508-973-2432

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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Directions to “SOUTHCOAST PHYSICIANS GROUP, INC. ” Practice Location

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