Provider Demographics
NPI:1942551445
Name:HANCOCK MEDICAL HEALTH SERVICES
Entity Type:Organization
Organization Name:HANCOCK MEDICAL HEALTH SERVICES
Other - Org Name:HANCOCK MEDICAL HEALTH SERVICES - BWSD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-467-8787
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 1:750 BLUE MEADOW ROAD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520
Practice Address - Country:US
Practice Address - Phone:228-463-9375
Practice Address - Fax:228-493-9371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANCOCK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
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