Organization Name: | SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. |
NPI Number: | 1023087400 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEROLDEAN DYSE (EXECUTIVE DIRECTOR) |
Mailing Address: | 404 Lillie Burney St Hattiesburg |
State: | MS US |
Postal Code: | 394015505 |
Phone Number: | 6014506500 |
Fax Number: | 6014506503 |
NPI Enumeration Date: | 03/16/2006 |
NPI Last Update Date: | 03/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |