Healthcare Provider Details

I. General information

NPI: 1740623990
Provider Name (Legal Business Name): HANCOCK MEDICAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540B SHEPHERD SQ
DIAMONDHEAD MS
39525-3325
US

IV. Provider business mailing address

149 DRINKWATER RD ATTN: REBECCA THERIOT
BAY ST LOUIS MS
39520-1658
US

V. Phone/Fax

Practice location:
  • Phone: 228-395-1234
  • Fax: 228-395-1235
Mailing address:
  • Phone: 228-467-8676
  • Fax: 228-467-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. GUY KEN SMITH
Title or Position: DIRECTOR OPERATIONS
Credential: MBA
Phone: 985-898-7091