| Outreach Health Services,inc. | |
| 
					130 North High Street Shubuta MS 39360  | |
| (601) 687-5859 | |
| (601) 687-5408 | 
| Full Name | Outreach Health Services,inc. | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 130 North High Street, Shubuta, Mississippi | 
| Authorized Official Name and Position | Sabrina Howze (EXECUTIVE DIRECTOR) | 
| Authorized Official Contact | 6016875859 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Outreach Health Services,inc. Po Box 527 130 N High St Shubuta MS 39360-0527 Ph: (601) 687-5859  | Outreach Health Services,inc. 130 North High Street Shubuta MS 39360 Ph: (601) 687-5859  | 
| NPI Number | 1548359565 | 
|---|---|
| Provider Enumeration Date | 10/11/2006 | 
| Last Update Date | 03/09/2015 | 
| Medicare PECOS PAC ID | 1951386911 | 
|---|---|
| Medicare Enrollment ID | O20040623000333 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1548359565 | NPI | - | NPPES | 
| 08384012 | Medicaid | MS | |
| 09013496 | Medicaid | MS | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary | 
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary | 
| Provider Name | Jackie E Mchenry | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1649252057 PECOS PAC ID: 3971412743 Enrollment ID: I20070710000205  | 
| Provider Name | Hatem Mourad | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1730220070 PECOS PAC ID: 8123181146 Enrollment ID: I20100831000704  | 
| Provider Name | Kendall Thornton | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1134491806 PECOS PAC ID: 0840458592 Enrollment ID: I20120227000333  | 
| Provider Name | Caron C Henderson | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1316253115 PECOS PAC ID: 2466612825 Enrollment ID: I20120322000576  | 
| Provider Name | Chasity M Sisson | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1992983829 PECOS PAC ID: 5890983381 Enrollment ID: I20150401000450  | 
| Provider Name | Shanika Boyd | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1578920328 PECOS PAC ID: 1254635014 Enrollment ID: I20160215002580  | 
| Provider Name | Robert William Dycus | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1568095453 PECOS PAC ID: 8628498466 Enrollment ID: I20201202000262  |