Provider Demographics
NPI:1407182454
Name:HANCOCK MEDICAL CENTER
Entity Type:Organization
Organization Name:HANCOCK MEDICAL CENTER
Other - Org Name:HANCOCK PATHOLOGY SERVICES
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:PO BOX 2790
Mailing Address - Street 2:
Mailing Address - City:BAY ST 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 1:149 DRINKWATER BLVD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1658
Practice Address - Country:US
Practice Address - Phone:228-467-8700
Practice Address - Fax:228-467-8799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANCOCK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-27
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11214207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty