1174543045 NPI number — SOUTHCOAST HOSPITALS GROUP, INC

Table of content: (NPI 1174543045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174543045 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:
6
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:
1174543045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MILL RD
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
FAIRHAVEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02719-5252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-973-3300
Provider Business Mailing Address Fax Number:
508-973-3305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MILL RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
FAIRHAVEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02719-5252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-973-3300
Provider Business Practice Location Address Fax Number:
508-973-3305
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLANAGAN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR AMBULATORY PHARMACY SERVIC
Authorized Official Telephone Number:
508-961-5760

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  V113 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 804513 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2241139 . This is a "NCPDP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 602683000 . This is a "US DPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0034635 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0408221 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HT0096 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000022409 . This is a "BMC HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 702122 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6000002 . This is a "UNITED HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6300655 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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