Healthcare Provider Details

I. General information

NPI: 1104874874
Provider Name (Legal Business Name): SOUTHCOAST PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE SUITE 104
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

1030 PRESIDENT AVE SUITE 104
FALL RIVER MA
02720-5923
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-3411
  • Fax: 508-235-6656
Mailing address:
  • Phone: 508-676-3411
  • Fax: 508-235-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY M HODGSON
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 508-985-2011