Organization
SOUTHCOAST PRIMARY CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY HODGSON (EXECUTIVE DIRECTOR)
(508) 985-2011
Entity
Organization
Contact information
Practice address
109 FAIRHAVEN ROAD, SOUTHCOAST PRIMARY CARE INC, MATTAPOISETT, MA 02739
(508) 758-3781
(508) 758-4455
Mailing address
370 FAUNCE CORNER RD, SOUTHCOAST PRIMARY CARE INC, NORTH DARTMOUTH, MA 02747
(508) 985-2000
(508) 985-2001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9782036
—
MA
01
—
CE9725
RAILROAD MEDICARE
MA
01
—
M16797
BCBS MASSACHUSETTS
MA
Enumeration date
10/11/2005
Last updated
03/05/2008
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