| Southeast Mississippi Rural Health Initiative, Inc. | |
|
301 South 4th Street Mount Olive MS 39119-0000 | |
| (601) 545-8700 | |
| (601) 450-2493 |
| Full Name | Southeast Mississippi Rural Health Initiative, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 301 South 4th Street, Mount Olive, Mississippi |
| Authorized Official Name and Position | Kaye Ray (CEO) |
| Authorized Official Contact | 6015458700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| 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. 301 South 4th Street Mount Olive MS 39119-0000 Ph: (601) 545-8700 |
| NPI Number | 1457800146 |
|---|---|
| Provider Enumeration Date | 09/23/2016 |
| Last Update Date | 09/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457800146 | NPI | - | NPPES |
| 03687771 | Medicaid | MS | |
| 251051 | Other | MS MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |