1205532090 NPI number — SOUTHCOAST HOSPITALS GROUP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205532090 NPI number — SOUTHCOAST HOSPITALS GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHCOAST HOSPITALS GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205532090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 PAGE ST
Provider Second Line Business Mailing Address:
SOUTHCOAST PHARMACY
Provider Business Mailing Address City Name:
NEW BEDFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02740-3464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-973-5760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 MILL RD
Provider Second Line Business Practice Location Address:
SOUTHCOAST SPECIALTY PHARMACY
Provider Business Practice Location Address City Name:
FAIRHAVEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-973-3320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROUGHMAN
Authorized Official First Name:
WADE
Authorized Official Middle Name:
DUDLEY
Authorized Official Title or Position:
EVP - CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
508-973-2908

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DS89929 . This is a "STATE BOARD OF PHARMACY LICENSE NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".