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General NPI Number Information
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NPI Number | 1750869681
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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 | 08/02/2018
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 200 MILL RD STE 180
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City | FAIRHAVEN
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State | MA
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Zip | 02719-5255
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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 RD STE 180
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City | FAIRHAVEN
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State | MA
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Zip | 02719-5255
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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 | MANAGER, PAYER CREDENTIALING
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Name | HEATHER NESBY
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Credential |
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Telephone | 508-973-7014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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