Provider Demographics
NPI:1124379631
Name:HANCOCK MEDICAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:HANCOCK MEDICAL HEALTH SERVICES, INC.
Other - Org Name:HANCOCK MEDICAL HEALTH SERVICES - HCSD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:KEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:985-898-7091
Mailing Address - Street 1:149 DRINKWATER BLVD.
Mailing Address - Street 2:
Mailing Address - City:BAY ST. LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520
Mailing Address - Country:US
Mailing Address - Phone:228-467-8676
Mailing Address - Fax:228-467-5597
Practice Address - Street 1:23350 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466
Practice Address - Country:US
Practice Address - Phone:228-255-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANCOCK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-24
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11-214363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty