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)

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251048	OTHER		MS MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1497202527
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	:	601-450-2493

Provider Business Practice Location Address
First Line	:	401 DOGWOOD STREET
Second Line	:
City	:	COLLINS
State	:	MS
Zip	:	39428-0000
Country	:	US
Telephone Number	:	601-765-4383
Fax Number	:	601-450-2493

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	DR. KAYE RAY
Credential	:	CEO
Telephone Number	:	601-545-8700

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/02/2022

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Directions to “SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. ” Practice Location

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