Provider Demographics
NPI:1205532090
Name:SOUTHCOAST HOSPITALS GROUP INC
Entity type:Organization
Organization Name:SOUTHCOAST HOSPITALS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP - CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:DUDLEY
Authorized Official - Last Name:BROUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-973-2908
Mailing Address - Street 1:101 PAGE ST
Mailing Address - Street 2:SOUTHCOAST PHARMACY
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3464
Mailing Address - Country:US
Mailing Address - Phone:508-973-5760
Mailing Address - Fax:
Practice Address - Street 1:206 MILL RD
Practice Address - Street 2:SOUTHCOAST SPECIALTY PHARMACY
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719
Practice Address - Country:US
Practice Address - Phone:508-973-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADS89929OtherSTATE BOARD OF PHARMACY LICENSE NUMBER