SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. (NPI# 1871927517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871927517 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. |
| Other Organization Name | PHARMACY ASSISTANCE CENTER |
| Practice Address |
62 Old Airport Rd Hattiesburg MS 39401-8382 |
| Mailing Address |
Po Box 1729 Hattiesburg MS 39403-1729 |
| Practice Telephone | 6014505661 |
| Practice Fax Number | 6015448627 |
| Mailing Telephone | 6015453700 |
| Mailing Fax Number | 6014502493 |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2013-08-29 |
| Authorized Official Name | MRS. GEROLDEAN DYSE (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6015458700 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
06374/ 5.2 | MS | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | PERMIT# 06374/5.2 - (LIMITED CLOSED DOOR) | 06374/5.2 | 01 |
| MS | CONTROLLED SUBSTANCE REGISTRATION | CS06374/5.2 | 01 |
| Other Name | Type Code |
|---|---|
| Pharmacy Assistance Center | 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 |
62 OLD AIRPORT RD |
| City | HATTIESBURG |
| State | MS |
| Zip Code | 39401-8382 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821093691 | John Michael Woods | Obstetrics & Gynecology | 62 Old Airport Rd, Hattiesburg, MS 39401 | 2005-06-16 |
| 1427556349 | Candace Johnson | Nurse Practitioner | 62 Old Airport Rd, Hattiesburg, MS 39401-8382 | 2018-01-25 |
| 1386154243 | Martia Moffett | Social Worker | 62 Old Airport Rd, Hattiesburg, MS 39401-8382 | 2017-10-05 |
| 1831167998 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 62 Old Airport Rd, Hattiesburg, MS 39401-8382 | 2006-03-14 |
| 1306819891 | Eugene Linwood Shannon | Obstetrics & Gynecology | 62 Old Airport Rd, Hattiesburg, MS 39401-8382 | 2006-02-07 |
| 1588637052 | Arthur Dean Cromartie | Obstetrics & Gynecology | 62 Old Airport Rd, Hattiesburg, MS 39401-8382 | 2006-02-07 |
| 1881675312 | Hilda J Mcgee | Obstetrics & Gynecology | 62 Old Airport Rd, Hattiesburg, MS 39401-8382 | 2005-11-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598315863 | Lisa Thornton | Technician | 18 Timberline Dr., Hattiesburg, MS 39401 | 2019-09-18 |
| 1548813637 | Caroline Estes Barnes | Counselor | Barnes, 8 App Slade Road, Hattiesburg, MS 39401 | 2019-07-18 |
| 1396252441 | Selection Healthcare Services, LLC | In Home Supportive Care | 606 Adeline St Ste 1c, Hattiesburg, MS 39401 | 2018-01-10 |
| 1225545585 | Whitney Wilkinson | Nurse Practitioner | 301 South 28th Avenue, Hattiesburg, MS 39401 | 2018-01-08 |
| 1740795806 | Forrest General Hospital | Pharmacy | 1414 South 28th Avenue, Hattiesburg, MS 39401 | 2017-12-11 |
| 1275058455 | Casey Payne | Pharmacist | 6130 Us 49, Hattiesburg, MS 39401 | 2017-08-08 |
| 1225562705 | Sarah Marie Hudson | Family Medicine | 6051 Us Highway 49 S, Hattiesburg, MS 39401 | 2017-04-12 |
| 1043671704 | The Covington's Cove Assisted Living Center LLC | Assisted Living Facility | 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 | 2016-03-09 |
| 1780083626 | Dominique Reed Watson | Pharmacist | 602 Adeline St, Hattiesburg, MS 39401 | 2014-08-15 |
| 1558778936 | Willie Davis Jr. | Day Training, Developmentally Disabled Services | 701 Duke Ave., Hattiesbiurg, MS 39401 | 2014-07-17 |
| Find all providers in zip 39401 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750402798 | University of Southern Mississippi | Pharmacy | 118 College Dr, Ste 5066, Hattiesburg, MS 39406-0002 | 2007-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417090093 | University Pavilion Pharmacy | Pharmacy | 1410 E Woodrow Wilson Dr, Jackson, MS 39216 | 2007-02-14 |
| 1518040500 | Region Iv Mh Mr Commission Phcy | Pharmacy | 2301b E Chambers Dr, Booneville, MS 38829 | 2006-10-23 |
| 1295268985 | Southern Pharmacy Clinical Management | Pharmacy | 3224 Dijon Ave, Ocean Springs, MS 39564-8520 | 2017-04-10 |
| 1912452921 | Sports Medicine Pharmacy LLC | Pharmacy | 1325 E Fortification St, Jackson, MS 39202-2442 | 2016-08-19 |
| 1689039711 | River Region Health System | Pharmacy | 2100 Highway 61 N, Pharmacy, Vicksburg, MS 39183-8211 | 2015-12-16 |
| 1891171351 | Prime Urgent Medical Clinic | Pharmacy | 176 Goodman Rd W, Southaven, MS 38671-9405 | 2015-08-07 |
| 1578956264 | Alliance Healthcare System | Pharmacy | 1938 Crescent Meadows Dr, Holly Springs, MS 38635-7419 | 2015-03-05 |
| 1689915423 | Region Iv Desoto County Pharmacy | Pharmacy | 2705 Highway 51 S, Hernando, MS 38632-2634 | 2013-03-04 |
| 1740417922 | Coastal Family Health Center, Inc. | Pharmacy | 1025 Division St, Ste A, Biloxi, MS 39530-2906 | 2009-06-16 |
| 1508072273 | Foot Solutions LLC | Pharmacy | 120 Market St, Woodland, MS 39776-9104 | 2007-05-16 |
| Find all providers with the same taxonomy | ||||
| City | HATTIESBURG |
| Zip Code | 39401 |
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.