Provider Demographics
NPI:1346279221
Name:JOSEPH E. HANCOCK MD PA
Entity Type:Organization
Organization Name:JOSEPH E. HANCOCK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-761-0747
Mailing Address - Street 1:PO BOX 64864
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-4864
Mailing Address - Country:US
Mailing Address - Phone:806-785-2045
Mailing Address - Fax:806-785-0872
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:STE 360
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-761-0747
Practice Address - Fax:806-761-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8676207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156999802Medicaid
A47818Medicare UPIN
TX156999802Medicaid
TX128124809Medicaid