SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. (NPI# 1003153073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003153073 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. |
| Other Organization Name | PETAL HIGH SCHOOL |
| Practice Address |
1145 Highway 42 Petal MS 39465-9740 |
| Mailing Address |
Po Box 1729 Hattiesburg MS 39403-1729 |
| Practice Telephone | 6015458700 |
| Practice Fax Number | 6014502493 |
| Mailing Telephone | 6015453700 |
| Mailing Fax Number | 6014502493 |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2013-01-11 |
| Authorized Official Name | GEROLDEAN DYSE (C E O) |
| Authorized Official Telephone | 6015458700 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
MS | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Petal High School | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407363559 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 215 Old Highway 49 E, Brooklyn, MS 39425-9028 | 2018-01-10 |
| 1952814469 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 64 Old Airport Rd, Hattiesburg, MS 39401-8382 | 2017-11-07 |
| 1053862524 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 104 Carver Drive, Collins, MS 39428 | 2016-10-20 |
| 1477004463 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 824 Hopewell Rd, Collins, MS 39428-5736 | 2016-10-14 |
| 1942751938 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 1208 Dogwood Ave, Collins, MS 39428-4160 | 2016-10-14 |
| 1457800146 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 301 South 4th Street, Mount Olive, MS 39119-0000 | 2016-09-23 |
| 1497202527 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 401 Dogwood Street, Collins, MS 39428-0000 | 2016-09-07 |
| 1184961153 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 60 Herrington Rd, Petal, MS 39465-8842 | 2013-01-11 |
| 1932446051 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 1179 Highway 42, Petal, MS 39465-9740 | 2013-01-09 |
| 1427328889 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 301 Hutchinson Ave, Hattiesburg, MS 39401-4134 | 2012-01-03 |
| Street Address |
1145 HIGHWAY 42 |
| City | PETAL |
| State | MS |
| Zip Code | 39465-9740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780646943 | Anna Christine Powell | Specialist/Technologist | 1145 Highway 42, Petal, MS 39465-9740 | 2006-04-04 |
| 1134285273 | Pedro Saul Moreno | Specialist | 1145 Highway 42, Petal, MS 39465-9740 | 2006-12-30 |
| 1447359229 | John Paul Bumgardner | Specialist | 1145 Highway 42, Petal, MS 39465-9740 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164055489 | R&p Elite Services, LLC | Private Vehicle | 68 Springfield Rd., Petal, MS 39465 | 2020-02-14 |
| 1003460544 | Hayden White | Pharmacist | 36 Byrd Dr., Petal, MS 39465 | 2019-08-01 |
| 1134612971 | Chandler Mccarley Hawkins | Dentist | 1115 Evelyn Gandy Parkway, Petal, MS 39465 | 2018-06-06 |
| 1881199818 | Lauren O'neal Garner | Nurse Practitioner | 36 Stadium Drive, Petal, MS 39465 | 2018-03-30 |
| 1700036928 | Petal School District | Registered Nurse | 60 Herrington Road, Petal, MS 39465 | 2008-09-24 |
| 1962679043 | Hattiesburg Eye Clinic Pa | Optometrist | 1223 Hwy 42, Ste 140, Petal, MS 39465 | 2008-05-08 |
| 1023228640 | Noal Baxter Cochran | Marriage & Family Therapist | 80 Lakeland Circle, Petal, MS 39465 | 2007-05-23 |
| 1750596938 | James A Nicholson Dds Pa | Dentist | 120 South 28th Avenue, Hattiesburg, MS 39465 | 2007-05-11 |
| 1356563605 | Petal School District | Registered Nurse | 400 Hillcrest Loop, Petal, MS 39465 | 2007-05-03 |
| 1154480804 | Mary E Thomsen | Orthotic Fitter | 173 Cherry Oak Trail, Petal, MS 39465 | 2006-12-08 |
| Find all providers in zip 39465 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720327919 | Southeast Mississippi Rural Health Initiative, Inc | Clinic/Center | 203 Highway 42, Petal, MS 39465-2864 | 2013-02-07 |
| 1184961153 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 60 Herrington Rd, Petal, MS 39465-8842 | 2013-01-11 |
| 1932446051 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 1179 Highway 42, Petal, MS 39465-9740 | 2013-01-09 |
| 1225073968 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 9214 Highway 42, Petal, MS 39465-8604 | 2006-06-17 |
| 1952724650 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 36 Panther Stadium Dr, Petal, MS 39465-3632 | 2014-01-31 |
| 1821335894 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 400 Hillcrest Loop, Petal, MS 39465-2634 | 2013-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871193722 | Coastal Family Health Center, Inc | Clinic/Center | 12424 Highway 57, Vancleave, MS 39565-8608 | 2020-10-29 |
| 1992305445 | Coastal Family Health Center, Inc | Clinic/Center | 5500 Hurley Wade Rd, Moss Point, MS 39562-8548 | 2020-10-26 |
| 1841890399 | Coastal Family Health Center, Inc | Clinic/Center | 10700 Yellow Jacket Rd, Ocean Springs, MS 39564-8038 | 2020-10-26 |
| 1033755343 | Access Family Health Services, Inc. | Clinic/Center | 179 Mullen Ave, Nettleton, MS 38858-6033 | 2019-11-21 |
| 1285280180 | Delta Health Center, Inc | Clinic/Center | 506 Washington Avenue, Moorhead, MS 38761 | 2019-08-15 |
| 1265088421 | Delta Health Center, Inc | Clinic/Center | 400 South Blvd, Drew, MS 38737-3508 | 2019-08-14 |
| 1215583356 | Delta Health Center, Inc. | Clinic/Center | 302 College Ave, Indianola, MS 38751-2112 | 2019-08-14 |
| 1063068252 | Delta Health Center, Inc | Clinic/Center | 1101 Oak St, Inverness, MS 38753-8725 | 2019-08-13 |
| 1750937959 | Delta Health Center, Inc | Clinic/Center | 212 E Claiborne St, Sunflower, MS 38778-9640 | 2019-08-13 |
| 1750937108 | Delta Health Center, Inc | Clinic/Center | 410 L F Packer Dr, Ruleville, MS 38771-3604 | 2019-08-12 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.