Basic Information
| Provider Information | |||||||||
| NPI: | 1730502055 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HANCOCK MEDICAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 DRINKWATER BLVD. | ||||||||
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| City: | BAY ST. LOUIS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284678676 | ||||||||
| FaxNumber: | 2284678674 | ||||||||
| Practice Location | |||||||||
| Address1: | 5435 GEX ROAD | ||||||||
| Address2: | |||||||||
| City: | DIAMONDHEAD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2284678676 | ||||||||
| FaxNumber: | 2284678674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2014 | ||||||||
| LastUpdateDate: | 01/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | KEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9858987079 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.