Provider Demographics
NPI:1891783189
Name:SOUTHCOAST PRIMARY CARE INC
Entity Type:Organization
Organization Name:SOUTHCOAST PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-985-2011
Mailing Address - Street 1:370 FAUNCE CORNER RD
Mailing Address - Street 2:SOUTHCOAST PRIMARY CARE INC
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-985-2000
Mailing Address - Fax:508-985-2001
Practice Address - Street 1:109 FAIRHAVEN ROAD
Practice Address - Street 2:SOUTHCOAST PRIMARY CARE INC
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739
Practice Address - Country:US
Practice Address - Phone:508-758-3781
Practice Address - Fax:508-758-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACE9725OtherRAILROAD MEDICARE
MA9782036Medicaid
MAM16797OtherBCBS MASSACHUSETTS
MAM20475Medicare PIN