Healthcare Provider Details

I. General information

NPI: 1730502055
Provider Name (Legal Business Name): HANCOCK MEDICAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 GEX ROAD
DIAMONDHEAD MS
39525
US

IV. Provider business mailing address

149 DRINKWATER BLVD.
BAY ST. LOUIS MS
39520
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEN SMITH
Title or Position: DIRECTOR OF OPERATIONS
Credential: MBA
Phone: 985-898-7079