Provider Demographics
NPI:1679157028
Name:SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC
Entity type:Organization
Organization Name:SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-545-8700
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-450-0231
Practice Address - Street 1:1201 BILBO RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:MS
Practice Address - Zip Code:39455-8670
Practice Address - Country:US
Practice Address - Phone:601-796-4483
Practice Address - Fax:601-796-9437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-11
Last Update Date:2022-09-06
Deactivation Date:2021-07-20
Deactivation Code:
Reactivation Date:2022-07-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)