1003007006 NPI number — HANCOCK MEDICAL CENTER

Table of content: (NPI 1003007006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003007006 NPI number — HANCOCK MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANCOCK MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIAMONDMED URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003007006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 2790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SAINT LOUIS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39521-2790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-467-8700
Provider Business Mailing Address Fax Number:
228-467-8799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4540 SHEPHERD SQUARE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DIAMONDHEAD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-255-8216
Provider Business Practice Location Address Fax Number:
228-255-8219
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WADE
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
228-467-8700

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  11214 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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