Healthcare Provider Details

I. General information

NPI: 1730118068
Provider Name (Legal Business Name): HANCOCK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 DRINKWATER BLVD
BAY SAINT LOUIS MS
39520-1658
US

IV. Provider business mailing address

149 DRINKWATER RD
BAY SAINT LOUIS MS
39520-1658
US

V. Phone/Fax

Practice location:
  • Phone: 228-467-8787
  • Fax: 228-467-8799
Mailing address:
  • Phone: 228-467-8787
  • Fax: 228-467-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11214
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11214
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11214
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11214
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number11214
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11214
License Number StateMS
# 7
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11214
License Number StateMS

VIII. Authorized Official

Name: MR. THOMAS P RAMSEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 228-467-8787