MEDICARE: PETAL ELEMENTARY SCHOOL

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	:	1932446051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETAL ELEMENTARY SCHOOL

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	:	1179 HIGHWAY 42
Second Line	:
City	:	PETAL
State	:	MS
Zip	:	39465-9740
Country	:	US
Telephone Number	:	601-545-8700
Fax Number	:	601-450-2493

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

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	02/05/2026

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Directions to “PETAL ELEMENTARY SCHOOL ” Practice Location

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