MEDICARE: HANCOCK MEDICAL HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	11217	MS
2	261QM1300X	Multi-Specialty Clinic/Center		MS

General Provider Information

NPI Number	:	1285943514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANCOCK MEDICAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2790
Second Line	:
City	:	BAY ST LOUIS
State	:	MS
Zip	:	39521-2790
Country	:	US
Telephone Number	:	228-467-8700
Fax Number	:	228-467-8799

Provider Business Practice Location Address
First Line	:	952 GREEN MEADOW RD
Second Line	:
City	:	BAY ST LOUIS
State	:	MS
Zip	:	39520-1620
Country	:	US
Telephone Number	:	228-467-1386
Fax Number	:	228-467-1770

Authorized Official
Title or Position	:	DIRECTOR OPERATIONS
Name	:	MR. GUY KEN SMITH
Credential	:	MBA
Telephone Number	:	985-898-7091

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	05/02/2014

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