Healthcare Provider Details

I. General information

NPI: 1871927517
Provider Name (Legal Business Name): SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 OLD AIRPORT RD
HATTIESBURG MS
39401-8382
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-450-5661
  • Fax: 601-544-8627
Mailing address:
  • Phone: 601-545-3700
  • Fax: 601-450-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number06374/ 5.2
License Number StateMS

VIII. Authorized Official

Name: MRS. KAYE RAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 601-545-8700