Basic Information
| Provider Information | |||||||||
| NPI: | 1457660797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HANCOCK MEDICAL HEALTH SERVICES, INC. | ||||||||
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| OtherOrganizationName: | HANCOCK MEDICAL PEDIATRIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 DRINKWATER BLVD. | ||||||||
| Address2: | |||||||||
| City: | BAY ST LOUIS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284678700 | ||||||||
| FaxNumber: | 2284678799 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 THAMES AVE | ||||||||
| Address2: | |||||||||
| City: | BAY ST LOUIS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395205002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284671320 | ||||||||
| FaxNumber: | 2284673233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 05/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | GUY | ||||||||
| AuthorizedOfficialMiddleName: | KEN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9858987091 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 11217 | MS | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 261QM1300X | MS | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.