Provider Demographics
NPI:1730502055
Name:HANCOCK MEDICAL HEALTH SERVICES
Entity Type:Organization
Organization Name:HANCOCK MEDICAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:985-898-7079
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:228-467-8674
Practice Address - Street 1:5435 GEX ROAD
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525
Practice Address - Country:US
Practice Address - Phone:228-467-8676
Practice Address - Fax:228-467-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty