MEDICARE: HANCOCK PHYSICIAN SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1750835385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANCOCK PHYSICIAN SERVICES, LLC

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 DRINKWATER RD
Second Line	:
City	:	BAY SAINT LOUIS
State	:	MS
Zip	:	39520-1658
Country	:	US
Telephone Number	:	228-467-8669
Fax Number	:

Authorized Official
Title or Position	:	DIVISION PRESIDENT
Name	:	JAMES GUIDRY JR.
Credential	:
Telephone Number	:	337-354-1200

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	08/11/2016

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Directions to “HANCOCK PHYSICIAN SERVICES, LLC ” Practice Location

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