Healthcare Provider Details

I. General information

NPI: 1124379631
Provider Name (Legal Business Name): HANCOCK MEDICAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23350 HIGHWAY 43
PICAYUNE MS
39466
US

IV. Provider business mailing address

149 DRINKWATER BLVD.
BAY ST. LOUIS MS
39520
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-6264
  • Fax:
Mailing address:
  • Phone: 228-467-8676
  • Fax: 228-467-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11-214
License Number StateMS

VIII. Authorized Official

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