HANCOCK MEDICAL CENTER (DIAMONDMED URGENT CARE) - NPI NUMBER 1003007006

Summary

Provider Name: HANCOCK MEDICAL CENTER (DIAMONDMED URGENT CARE)

NPI Number: 1003007006

Clasification: Clinic/Center (261QU0200X)

Specialization: Urgent Care

Address:
4540 SHEPHERD SQUARE
SUITE B
DIAMONDHEAD, MS
ZIP 39525

Phone Number: (228) 255-8216



Detailed Information

HANCOCK MEDICAL CENTER is an urgent care clinic/center in Diamondhead, MS. The assigned NPI number for this provider is 1003007006 and is registered as an organization entity type.
The provider Is Doing Business As Diamondmed Urgent Care.

The provider's business address is:

4540 SHEPHERD SQUARE
SUITE B
DIAMONDHEAD, MS
ZIP 39525
Phone: (228) 255-8216
Fax: (228) 255-8219

The provider's authorized official is Donald L Wade .
The authorized official title is Chief Financial Officer and has the following contact phone number (228) 467-8700.

The enumeration date for this NPI number is 8/5/2007 and was last updated on 10/8/2009.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1659673606 DIAMONDHEAD URGENT CARE
Clinic/Center (Urgent Care)
1508010828 URGENT CARE INC
Clinic/Center (Urgent Care)
1922317478 HANCOCK MEDICAL HEALTH SERVICES, INC.
Clinic/Center (Urgent Care)
1093811051 KEITH VAN METER & ASSOCIATES
Clinic/Center (Multi-Specialty)
1043437684 THE BEACH SURGICAL GROUP
Clinic/Center
1124016209 COASTAL FAMILY HEALTH CENTER, INC
Clinic/Center (Federally Qualified Health Center (FQHC))
1447362207 BIO-MEDICAL APPLICATIONS OF MISSISSIPPI, INC.
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QU0200X Clinic/Center Urgent Care 11214 MS Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1003007006 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name HANCOCK MEDICAL CENTER The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name DIAMONDMED URGENT CARE Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 4540 SHEPHERD SQUARE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE B The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name DIAMONDHEAD The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name MS The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 39525 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 2282558216 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 2282558219 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 8/5/2007 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 10/8/2009 The date that a record was last updated or changed.
17 Authorized Official Last Name WADE The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name DONALD The first name of the authorized official.
19 Authorized Official Middle Name L The middle name of the authorized official.
20 Authorized Official Title or Position CHIEF FINANCIAL OFFICER The title or position of the authorized official.
21 Authorized Official Telephone Number 2284678700 The 10-position telephone number of the authorized official.
22 Healthcare Provider Taxonomy Code 1 261QU0200X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
23 Provider License Number 1 11214 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
24 Provider License Number State Code 1 MS The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
25 Healthcare Provider Primary Taxonomy Switch 1 Y
26 Is Organization Subpart Y
27 Parent Organization LBN HANCOCK MEDICAL CENTER
28 Parent Organization TIN
29 Authorized Official Name Prefix Text MR.
30 Authorized Official Credential Text CPA

Download Record

Download this NPI record in Text format: Export

Download this NPI record in Excel (CSV) format: Export

Download this NPI record in XML format: Export




This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.