| Name: | SOUTHCOAST PHYSICIANS GROUP, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Foreign Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 13 Nov 1996 (28 years ago) |
| Identification Number: | 000092328 |
| Principal Address: | 101 PAGE STREET, NEW BEDFORD, MA, 02740, USA |
| Purpose: | TO EMPLOY COMMUNITY PHYSICIANS AND OTHER PRACTITIONERS. |
| NAICS: | 813920 - Professional Organizations |
| Fictitious names: |
Southcoast Health (trading name, 2021-01-12 - ) |
| Historical names: |
BRISTOL MEDICAL MANAGEMENT, INC. Southcoast Physician Services, Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841787652 | 2018-04-17 | 2018-04-17 | 200 MILL RD STE 180, FAIRHAVEN, MA, 027195255, US | 670 AQUIDNECK AVENUE, MIDDLETOWN, RI, 02841, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 508-973-2000 |
| Fax | 5089732001 |
| Phone | +1 508-973-2432 |
| Fax | 5089732435 |
Authorized person
| Name | KIMBERLEY COON |
| Role | DIRECTOR, MEDICAL STAFF SVCS |
| Phone | 5089735006 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | No |
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 709004034 |
| State | RI |
| Issuer | RAILROAD MEDICARE |
| Number | CD2506 |
| State | MA |
| Issuer | MEDICAID |
| Number | 110072422A |
| State | MA |
| Issuer | MEDICAID |
| Number | BM20689 |
| State | RI |
| Issuer | MEDICARE |
| Number | M20518 |
| State | MA |
| Name | Role | Address |
|---|---|---|
| DANIEL SULLIVAN, ESQ. | Agent | ROBINSON & COLE LLP ONE FINANCIAL PLAZA SUITE 1430, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| DAVID MCCREADY | PRESIDENT | 8 DEAN CIRCLE ANDOVER, MA 01810 USA |
| Name | Role | Address |
|---|---|---|
| WADE BROUGHMAN | TREASURER | 25 BENJAMIN TRIPP ROAD WESTPORT, MA 02790 USA |
| Name | Role | Address |
|---|---|---|
| RENEE CLARK | CLERK | FIVE BLUEBERRY LANE MILLIS, MA 02054 USA |
| Name | Role | Address |
|---|---|---|
| DONALD G. GIUMETTI | DIRECTOR | 10 PRINCE SNOW CIRCLE MATTAPOISETT, MA 02739 USA |
| JASON RUA | DIRECTOR | 24 KYLE JACOB ROAD N. DARTMOUTH, MA 02747 USA |
| LOUIS A. CABRAL | DIRECTOR | 304 CHURCH POND DRIVE TIVERTON, RI 02878 USA |
| SALMAN BASHIR MD | DIRECTOR | 305 GREENWICH AVENUE WARWICK, RI 02886 USA |
| ELIZABETH HUIDEKOPER | DIRECTOR | 7 TERN LANE DARTMOUTH, MA 02748 USA |
| JEFFREY LAWRENCE MD | DIRECTOR | 1 WOODHAVEN DRIVE BARRINGTON, RI 02806 USA |
| CARMEN F SYLVESTER | DIRECTOR | 49 CAROLYN COURT SWANSEA, MA 02777 USA |
| DAVID MCCREADY | DIRECTOR | 8 DEAN CIRCLE ANDOVER, MA 01810 USA |
| CHRISTOPHER HODGSON | DIRECTOR | 165 ROCK O'DUNDEE ROAD S. DARTMOUTH, MA 02748 USA |
| DENNIS F FUSCO | DIRECTOR | 2 PRINCE SNOW CIRCLE MATTAPOISETT, MA 02739 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2012-04-11 | Southcoast Physician Services, Inc. | SOUTHCOAST PHYSICIANS GROUP, INC. |
| Name Change | 1998-07-14 | BRISTOL MEDICAL MANAGEMENT, INC. | Southcoast Physician Services, Inc. |
| Number | Name | File Date |
|---|---|---|
| 202445378890 | Annual Report | 2024-02-02 |
| 202327071020 | Annual Report | 2023-02-01 |
| 202218284270 | Annual Report | 2022-06-03 |
| 202197928820 | Annual Report | 2021-06-08 |
| 202185899260 | Fictitious Business Name Statement | 2021-01-12 |
| 202042562520 | Annual Report | 2020-06-19 |
| 201995751290 | Annual Report | 2019-06-07 |
| 201866958670 | Annual Report | 2018-05-24 |
| 201747097500 | Annual Report | 2017-07-06 |
| 201699464630 | Annual Report | 2016-05-27 |
Date of last update: 08 Oct 2024
Sources: Rhode Island Department of State
