Provider Demographics
NPI:1740623990
Name:HANCOCK MEDICAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:HANCOCK MEDICAL HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 RD
Mailing Address - Street 2:ATTN: REBECCA THERIOT
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1658
Mailing Address - Country:US
Mailing Address - Phone:228-467-8676
Mailing Address - Fax:228-467-8674
Practice Address - Street 1:4540B SHEPHERD SQ
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3325
Practice Address - Country:US
Practice Address - Phone:228-395-1234
Practice Address - Fax:228-395-1235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANCOCK MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-08
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty