| 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 |