Provider Demographics
NPI:1376565366
Name:SOUTHCOAST HOSPITALS GROUP INC
Entity Type:Organization
Organization Name:SOUTHCOAST HOSPITALS GROUP INC
Other - Org Name:SOUTHCOAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR AMBULATORY PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-973-5760
Mailing Address - Street 1:101 PAGE ST
Mailing Address - Street 2:SLH -- LOBBY
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3464
Mailing Address - Country:US
Mailing Address - Phone:508-973-5449
Mailing Address - Fax:508-973-5456
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-973-5449
Practice Address - Fax:508-973-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MA26413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0445223Medicaid
2038148OtherPK
MA0445223Medicaid
MA1977460002Medicare NSC