Healthcare Provider Details

I. General information

NPI: 1003007006
Provider Name (Legal Business Name): HANCOCK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 SHEPHERD SQUARE SUITE B
DIAMONDHEAD MS
39525
US

IV. Provider business mailing address

P.O. BOX 2790
BAY SAINT LOUIS MS
39521-2790
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-8216
  • Fax: 228-255-8219
Mailing address:
  • Phone: 228-467-8700
  • Fax: 228-467-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number11214
License Number StateMS

VIII. Authorized Official

Name: MR. DONALD L WADE
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 228-467-8700