Provider Demographics
NPI:1306871223
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:EXECUTIVE VICE PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIGG
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, FHFMA
Authorized Official - Phone:508-961-5016
Mailing Address - Street 1:363 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-3703
Mailing Address - Country:US
Mailing Address - Phone:508-679-3131
Mailing Address - Fax:
Practice Address - Street 1:363 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3703
Practice Address - Country:US
Practice Address - Phone:508-679-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHCOAST HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAV113282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000020852OtherBMC HEALTHNET
0000005124OtherBLUE CROSS RI
2222005510OtherBLUE CROSS MA
982009OtherTUFTS HEALTH PLAN
222200501OtherBLUE CROSS MA
5124-4OtherBLUE CROSS RI PLAN 65
MA110022082DMedicaid
RIOP20055Medicaid
MA220074OtherMEDICARE
900006OtherHARVARD PILGRIM
982008OtherTUFTS HEALTH PLAN
H00117OtherBLUE CHIP RI
S007424OtherTICARE FOR LIFE
RI0220055Medicaid
1201751OtherMA BEHAVIORAL HEALTH PART
2222005530OtherBLUE CROSS MA
MA110022082HMedicaid
2259416OtherCIGNA
2222005530OtherBLUE CROSS MA
2259416OtherCIGNA