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General NPI Number Information
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NPI Number | 1164499174
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Entity Type | Organization
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Legal Business Name | SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 598 W 11TH AVE
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City | LUMBERTON
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State | MS
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Zip | 39455-2350
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Country | US
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Telephone | 601-796-4215
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Fax | 601-796-9437
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Provider Business Mailing Address
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Address Line | P O BOX 1729
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City | LUMBERTON
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State | MS
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Zip | 39455-0000
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Country | US
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Telephone | 601-796-4215
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Fax | 601-796-9437
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. KAYE RAY
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Credential |
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Telephone | 601-545-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | MS
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