| Southeast Mississippi Rural Health Initiative, Inc. | |
| 
					1300 Beaumont Brooklyn Rd Beaumont MS 39423-2233  | |
| (601) 545-8700 | |
| (601) 582-5461 | 
| Full Name | Southeast Mississippi Rural Health Initiative, Inc. | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 1300 Beaumont Brooklyn Rd, Beaumont, Mississippi | 
| Authorized Official Name and Position | Kaye Ray (CEO) | 
| 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. 1300 Beaumont Brooklyn Rd Beaumont MS 39423-2233 Ph: (601) 545-8700  | 
| NPI Number | 1003852203 | 
|---|---|
| Provider Enumeration Date | 06/22/2006 | 
| Last Update Date | 09/06/2022 | 
| Medicare PECOS PAC ID | 2466342605 | 
|---|---|
| Medicare Enrollment ID | O20050324001248 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1003852203 | NPI | - | NPPES | 
| 01873344 | 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: 1411 Bradley Ave, Beaumont, MS 39423 Phone: 601-784-3922 Fax: 601-784-3755  |