MEDICARE: SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013967603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1729
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39403-1729
Country	:	US
Telephone Number	:	601-545-8700
Fax Number	:	601-582-5461

Provider Business Practice Location Address
First Line	:	2900 JAMESTOWN RD
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-2408
Country	:	US
Telephone Number	:	601-545-8700
Fax Number	:	601-582-5461

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	JANICE ROBINSON
Credential	:
Telephone Number	:	601-545-8700

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/03/2026

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