1922317478 NPI number — HANCOCK MEDICAL HEALTH SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922317478 NPI number — HANCOCK MEDICAL HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANCOCK MEDICAL HEALTH SERVICES, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1922317478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 DRINKWATER BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY ST LOUIS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39520
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:
5435 GEX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIAMONDHEAD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39525-3208
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:
10/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
GUY
Authorized Official Middle Name:
KEN
Authorized Official Title or Position:
DIRECTOR OPERATIONS
Authorized Official Telephone Number:
985-898-7091

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , 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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