Healthcare Provider Details

I. General information

NPI: 1689983546
Provider Name (Legal Business Name): HANCOCK MEDICAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 SHEPHERD SQ
DIAMONDHEAD MS
39525-3325
US

IV. Provider business mailing address

PO BOX 2790
BAY ST LOUIS MS
39521-2790
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-8526
  • Fax: 228-255-8527
Mailing address:
  • Phone: 228-467-8700
  • Fax: 228-467-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11217
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

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