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General NPI Number Information
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NPI Number | 1336137629
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Entity Type | Organization
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Legal Business Name | SOUTHCOAST PHYSICIANS GROUP, INC.
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 200 MILL ROAD SUITE 180
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City | FAIRHAVEN
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State | MA
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Zip | 02719-5252
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Country | US
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Telephone | 508-973-2000
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Fax | 508-973-2001
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Provider Business Mailing Address
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Address Line | 200 MILL ROAD SUITE 180
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City | FAIRHAVEN
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State | MA
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Zip | 02719-5252
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Country | US
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Telephone | 508-973-2000
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Fax | 508-973-2001
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Authorized Official
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Title or Position | SHS VICE PRESIDENT OF CONTRACTING
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Name | MELISSA ROSE
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Credential |
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Telephone | 508-973-2950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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