MEDICARE: HANCOCK MEDICAL HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	11214	MS
2	261QM2500X	Medical Specialty Clinic/Center		MS

General Provider Information

NPI Number	:	1912216466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANCOCK MEDICAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2790
Second Line	:
City	:	BAY ST LOUIS
State	:	MS
Zip	:	39521-2790
Country	:	US
Telephone Number	:	228-467-8700
Fax Number	:	228-467-8799

Provider Business Practice Location Address
First Line	:	3068 PORT AND HARBOR DR
Second Line	:
City	:	BAY ST LOUIS
State	:	MS
Zip	:	39520-9306
Country	:	US
Telephone Number	:	228-533-9000
Fax Number	:	228-533-9003

Authorized Official
Title or Position	:	DIRECTOR OPERATIONS
Name	:	MR. GUY KEN SMITH
Credential	:	MBA
Telephone Number	:	985-898-7091

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	05/01/2014

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