1467887562 NPI number — SOUTHCOAST CARDIOLOGY LLC

Table of content: (NPI 1467887562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467887562 NPI number — SOUTHCOAST CARDIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHCOAST CARDIOLOGY LLC
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:
1467887562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
177 GULF RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02748-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-992-7499
Provider Business Mailing Address Fax Number:
508-999-9880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 ALLEN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NEW BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02740-3373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-992-7499
Provider Business Practice Location Address Fax Number:
508-999-9880
Provider Enumeration Date:
09/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WEINSHEL
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SOLE MBR
Authorized Official Telephone Number:
774-992-7499

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110099282A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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