Healthcare Provider Details

I. General information

NPI: 1174543045
Provider Name (Legal Business Name): SOUTHCOAST HOSPITALS GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MILL RD SUITE 120
FAIRHAVEN MA
02719-5252
US

IV. Provider business mailing address

200 MILL RD SUITE 120
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-3300
  • Fax: 508-973-3305
Mailing address:
  • Phone: 508-973-3300
  • Fax: 508-973-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberV113
License Number StateMA

VIII. Authorized Official

Name: MR. SCOTT FLANAGAN
Title or Position: DIRECTOR AMBULATORY PHARMACY SERVIC
Credential: RPH.
Phone: 508-961-5760