Organization
SOUTHCOAST PHYSICIANS GROUP, INC.
Active
Other names
Southcoast Urgent Care Center - Lakeville
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLEY COON (DIRECTOR, MEDICAL STAFF SVCS)
(508) 973-2432
Entity
Organization
Contact information
Practice address
12 MAIN ST, LAKEVILLE, MA 02347-1606
(508) 973-2432
Mailing address
200 MILL RD STE 180, FAIRHAVEN, MA 02719-5255
(508) 973-2000
(508) 973-2001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
MA
207Q00000X
Family Medicine Physician
—
MA
207R00000X
Internal Medicine Physician
—
MA
208000000X
Pediatrics Physician
—
MA
208M00000X
Hospitalist Physician
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110072422A
—
MA
01
—
709004034
MEDICARE
RI
01
—
BM20689
MEDICAID - RI
RI
01
—
CD2506
RAILROAD MEDICARE
MA
01
—
M20518
MEDICARE
MA
Enumeration date
01/10/2018
Last updated
01/10/2018
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