SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC (NPI# 1881661874) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881661874 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC |
| Other Organization Name | NEW AUGUSTA FAMILY HEALTH CENTER |
| Practice Address |
404 Main Street New Augusta MS 39462-0000 |
| Mailing Address |
Po Box 1729 Hattiesburg MS 39403-1729 |
| Practice Telephone | 6019648391 |
| Practice Fax Number | 6019648398 |
| Mailing Telephone | 6015458700 |
| Mailing Fax Number | 6015825461 |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2013-12-30 |
| Authorized Official Name | GEROLDEAN DYSE (EXECUTIVE DIRECTOR) |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09013878 | 05 |
| Other Name | Type Code |
|---|---|
| New Augusta Family Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720327919 | Southeast Mississippi Rural Health Initiative, Inc | Clinic/Center | 203 Highway 42, Petal, MS 39465-2864 | 2013-02-07 |
| 1306881149 | Southeast Mississippi Rural Health Initiative, Inc | Clinic/Center | 8 Burborne St, Brooklyn, MS 39425-9732 | 2006-06-17 |
| 1346284650 | Southeast Mississippi Rural Health Initiative, Inc | Clinic/Center | 702 Eatonville Rd, Hattiesburg, MS 39401-9794 | 2006-06-16 |
| Street Address |
404 MAIN STREET |
| City | NEW AUGUSTA |
| State | MS |
| Zip Code | 39462-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689664039 | Joshua Peter Hand | Family Medicine | 404 Main Street, New Augusta, MS 39462-9788 | 2005-10-26 |
| 1235599515 | Charlene Hicks | Nurse Practitioner | 404 Main Street, New Augusta, MS 39462 | 2016-03-01 |
| 1720274327 | James Wallace Griffin Jr. | Family Medicine | 404 Main Street, New Augusta, MS 39462-0349 | 2007-09-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740226976 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 9899 U S Hwy 98 E, New Augusta, MS 39462-0000 | 2006-06-22 |
| 1639115207 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 100 8th Ave S, New Augusta, MS 39462-0000 | 2006-06-21 |
| 1912957135 | Tracy Hennessey | Nurse Practitioner | 404 Main St, New Augusta, MS 39462-0000 | 2006-05-10 |
| 1033514591 | Leann Nicole Evans | Nurse Practitioner | 404 Main St, New Augusta, MS 39462-0000 | 2014-10-27 |
| 1053598433 | Leslie Wells | Dentist | 203 Pine Street West, New Augusta, MS 39462-0411 | 2008-01-28 |
| 1225369705 | Leslie Wells Dmd, Pllc | Dentist | 203 Pine Street West, New Augusta, MS 39462-0411 | 2010-01-22 |
| 1437620580 | Kimberly Lashaun Coke | Nurse Practitioner | 105 Thomas Lane, New Augusta, MS 39462-3946 | 2018-12-16 |
| 1184035800 | Mississippi State Department of Health | Public Health or Welfare | 102 Main St, New Augusta, MS 39462-9616 | 2014-05-15 |
| 1295343028 | Latesha Rochelle Williams | Nurse Practitioner | 309 Mcswain Rd, New Augusta, MS 39462-9760 | 2020-07-17 |
| 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 |
|---|---|---|---|---|
| 1740226976 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 9899 U S Hwy 98 E, New Augusta, MS 39462-0000 | 2006-06-22 |
| 1639115207 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 100 8th Ave S, New Augusta, MS 39462-0000 | 2006-06-21 |
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| 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 | ||||
| City | NEW AUGUSTA |
| Zip Code | 39462 |
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.