Provider Demographics
NPI:1174543045
Name:SOUTHCOAST HOSPITALS GROUP, INC
Entity type:Organization
Organization Name:SOUTHCOAST HOSPITALS GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AMBULATORY PHARMACY SERVIC
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-961-5760
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-3300
Mailing Address - Fax:508-973-3305
Practice Address - Street 1:200 MILL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5252
Practice Address - Country:US
Practice Address - Phone:508-973-3300
Practice Address - Fax:508-973-3305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHCOAST HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAV113251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
804513OtherTUFTS
MA2241139OtherNCPDP
602683000OtherUS DPT OF LABOR
0034635OtherNEIGHBORHOOD HEALTH PLAN
MA0408221Medicaid
HT0096OtherBLUE CROSS
000000022409OtherBMC HEALTHNET
702122OtherHARVARD PILGRIM
6000002OtherUNITED HEALTH PLAN
6300655OtherAETNA
602683000OtherUS DPT OF LABOR