Provider Demographics
NPI:1003007006
Name:HANCOCK MEDICAL CENTER
Entity Type:Organization
Organization Name:HANCOCK MEDICAL CENTER
Other - Org Name:DIAMONDMED URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:228-467-8700
Mailing Address - Street 1:P.O. BOX 2790
Mailing Address - Street 2:
Mailing Address - City:BAY SAINT LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39521-2790
Mailing Address - Country:US
Mailing Address - Phone:228-467-8700
Mailing Address - Fax:228-467-8799
Practice Address - Street 1:4540 SHEPHERD SQUARE
Practice Address - Street 2:SUITE B
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525
Practice Address - Country:US
Practice Address - Phone:228-255-8216
Practice Address - Fax:228-255-8219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANCOCK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11214261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care