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

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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
1 NPI 1003007006
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name HANCOCK MEDICAL CENTER
5 Provider Other Organization Name DIAMONDMED URGENT CARE
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 4540 SHEPHERD SQUARE
8 Provider Second Line Business Practice Location Address SUITE B
9 Provider Business Practice Location Address City Name DIAMONDHEAD
10 Provider Business Practice Location Address State Name MS
11 Provider Business Practice Location Address Postal Code 39525
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 2282558216
14 Provider Business Practice Location Address Fax Number 2282558219
15 Provider Enumeration Date 8/5/2007
16 Last Update Date 10/8/2009
17 Authorized Official Last Name WADE
18 Authorized Official First Name DONALD
19 Authorized Official Middle Name L
20 Authorized Official Title or Position CHIEF FINANCIAL OFFICER
21 Authorized Official Telephone Number 2284678700
22 Healthcare Provider Taxonomy Code 1 261QU0200X
23 Provider License Number 1 11214
24 Provider License Number State Code 1 MS
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

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This page was last updated on: 8/12/2014
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