| Southeast Mississippi Rural Health Initiative, Inc. | |
|
44 Brooklyn Janice Rd Brooklyn MS 39425-9731 | |
| (601) 582-1188 | |
| (601) 582-8844 |
| Full Name | Southeast Mississippi Rural Health Initiative, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 44 Brooklyn Janice Rd, Brooklyn, Mississippi |
| Authorized Official Name and Position | Geroldean Dyse (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6015458700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Mississippi Rural Health Initiative, Inc. Po Box 1729 Hattiesburg MS 39403-1729 Ph: (601) 545-8700 | Southeast Mississippi Rural Health Initiative, Inc. 44 Brooklyn Janice Rd Brooklyn MS 39425-9731 Ph: (601) 582-1188 |
| NPI Number | 1659348076 |
|---|---|
| Provider Enumeration Date | 03/03/2006 |
| Last Update Date | 04/16/2021 |
| Medicare PECOS PAC ID | 2466342605 |
|---|---|
| Medicare Enrollment ID | O20091027000774 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659348076 | NPI | - | NPPES |
| C02142 | Other | MS | CAHABA MEDICARE GR NUMBER |
| 1821127 | Other | MS | MS UNITED HEALTH CARE |
| 09014664 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Mississippi) | Primary |
Southeast Mississippi Rural Health Initiative, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8 Burborne St, Brooklyn, MS 39425 Phone: 061-545-8700 Fax: 601-582-5461 | |
Southeast Mississippi Rural Health Initiative, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 215 Old Highway 49 E, Brooklyn, MS 39425 Phone: 601-545-8700 Fax: 601-450-2493 |