Organization
SOUTHCOAST PHYSICIANS GROUP, INC.
Active
Other names
Southcoast - Tufts Health Plan
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER NESBY (MANAGER, PAYER CREDENTIALING)
(508) 973-7014
Entity
Organization
Contact information
Practice address
200 MILL RD STE 180, FAIRHAVEN, MA 02719-5255
(508) 973-2000
(508) 973-2001
Mailing address
200 MILL RD STE 180, FAIRHAVEN, MA 02719-5255
(508) 973-2000
(508) 973-2001
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110072422A
—
MA
05
—
BM20689
—
RI
01
—
CD2506
RAILROAD MEDICARE
MA
Enumeration date
08/02/2018
Last updated
08/02/2018
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