| 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 |