Provider Demographics
NPI:1497956254
Name:SOUTHCOAST PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHCOAST PHYSICIAN SERVICES, INC.
Other - Org Name:WAREHAM SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-295-3900
Mailing Address - Street 1:370 FAUNCE CORNER RD
Mailing Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1271
Mailing Address - Country:US
Mailing Address - Phone:508-985-2000
Mailing Address - Fax:508-985-2001
Practice Address - Street 1:106 MAIN ST
Practice Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC DBA WAREHAM SURGICAL
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2122
Practice Address - Country:US
Practice Address - Phone:508-295-3900
Practice Address - Fax:508-295-3271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHCOAST PHYSICIAN SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-30
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty