1366751604 NPI number — HANCOCK MEDICAL HEALTH SERVICES, INC.

Table of content: (NPI 1366751604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366751604 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:
1366751604
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:
PO BOX 2790
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:
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:
100 DRINKWATER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY ST LOUIS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39520-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-463-8939
Provider Business Practice Location Address Fax Number:
228-463-8938
Provider Enumeration Date:
10/05/2010

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: 208600000X , with the licence number:  11217 , 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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