| Organization Name: | SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC |
| NPI Number: | 1720327919 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GEROLDEAN DYSE (CHIEF EXECUTIVE OFFICEER) |
| Mailing Address: | 203 Highway 42 Petal |
| State: | MS US |
| Postal Code: | 394652864 |
| Phone Number: | 6015846301 |
| Fax Number: | 6014502493 |
| NPI Enumeration Date: | 02/07/2013 |
| NPI Last Update Date: | 02/07/2013 |
| 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: | |