Healthcare Provider Details

I. General information

NPI: 1548359565
Provider Name (Legal Business Name): OUTREACH HEALTH SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 NORTH HIGH STREET
SHUBUTA MS
39360
US

IV. Provider business mailing address

PO BOX 527 130 N HIGH ST
SHUBUTA MS
39360-0527
US

V. Phone/Fax

Practice location:
  • Phone: 601-687-5859
  • Fax: 601-687-5408
Mailing address:
  • Phone: 601-687-5859
  • Fax: 601-687-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SABRINA HOWZE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 601-687-5859