Provider Demographics
NPI:1457660797
Name:HANCOCK MEDICAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:HANCOCK MEDICAL HEALTH SERVICES, INC.
Other - Org Name:HANCOCK MEDICAL PEDIATRIC
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:228-467-8700
Mailing Address - Fax:228-467-8799
Practice Address - Street 1:151 THAMES AVE
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-5002
Practice Address - Country:US
Practice Address - Phone:228-467-1320
Practice Address - Fax:228-467-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11217208000000X
MS261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty