Healthcare Provider Details

I. General information

NPI: 1730425802
Provider Name (Legal Business Name): HANCOCK MEDICAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 LEISURE TIME DR.
DIAMONDHEAD MS
39525
US

IV. Provider business mailing address

149 DRINKWATER BLVD.
BAY ST LOUIS MS
39520
US

V. Phone/Fax

Practice location:
  • Phone: 228-586-9229
  • Fax: 228-586-9230
Mailing address:
  • Phone: 228-467-8676
  • Fax: 228-467-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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