Basic Information
| Provider Information | |||||||||
| NPI: | 1134326259 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HANCOCK MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | HANCOCK FAMILY CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 DRINKWATER BLVD. | ||||||||
| Address2: | |||||||||
| City: | BAY SAINT LOUIS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395201658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284678787 | ||||||||
| FaxNumber: | 2284678799 | ||||||||
| Practice Location | |||||||||
| Address1: | 16230 HIGHWAY 603 | ||||||||
| Address2: | |||||||||
| City: | KILN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395666230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282555200 | ||||||||
| FaxNumber: | 2282555250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 03/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | RAMSEY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2284678787 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HANCOCK MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 11214 | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.