Organization
SOUTHCOAST PHYSICIANS GROUP, INC.
Active
Other names
Southcoast Physician Services, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA ROSE (SHS VICE PRESIDENT OF CONTRACTING)
(508) 973-2950
Entity
Organization
Contact information
Practice address
200 MILL ROAD, SUITE 180, FAIRHAVEN, MA 02719-5252
(508) 973-2000
(508) 973-2001
Mailing address
200 MILL ROAD, SUITE 180, FAIRHAVEN, MA 02719-5252
(508) 973-2000
(508) 973-2001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208600000X
Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9779752
—
MA
05
—
BM11666
—
RI
05
—
BM20689
—
RI
01
—
CD2506
RAILROAD MEDICARE
MA
01
—
CG4450
RAILROAD MEDICARE
MA
01
—
CN5678
RAILROAD MEDICARE
MA
01
—
M16989
BCBS MASSACHUSETTS
MA
01
—
M20518
MEDICARE PIN
MA
05
—
SP28498
—
RI
Enumeration date
10/11/2005
Last updated
06/28/2019
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