Basic Information
| Provider Information | |||||||||
| NPI: | 1922317478 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HANCOCK MEDICAL HEALTH SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DIAMONDMED URGENT CARE | ||||||||
| 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: | 5435 GEX RD | ||||||||
| Address2: | |||||||||
| City: | DIAMONDHEAD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395253208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2282558216 | ||||||||
| FaxNumber: | 2282558219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2010 | ||||||||
| LastUpdateDate: | 05/02/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| 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 | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | MS | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 261QM1300X | MS | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.