SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. (NPI# 1407363559) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1407363559 |
Entity Type | Organization |
Organization Name | SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC. |
Other Organization Name | FORREST AGRICULTURAL HIGH SCHOOL |
Practice Address |
215 Old Highway 49 E Brooklyn MS 39425-9028 |
Mailing Address |
Po Box 1729 Hattiesburg MS 39403-1729 |
Practice Telephone | 6015458700 |
Practice Fax Number | 6014502493 |
Mailing Telephone | 6015458700 |
Mailing Fax Number | 6014502493 |
Enumeration Date | 2018-01-10 |
Last Update Date | 2018-01-12 |
Authorized Official Name | GEROLDEAN M 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 | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Forrest Agricultural High School | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
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 |
1265461719 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 100 W Front St, Hattiesburg, MS 39401-3460 | 2006-06-30 |
Street Address |
215 OLD HIGHWAY 49 E |
City | BROOKLYN |
State | MS |
Zip Code | 39425-9028 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477884674 | Lisa Gayle Smith | Speech-Language Pathologist | 130 Sam Boyte Rd, Brooklyn, MS 39425-9501 | 2010-01-27 |
1659348076 | Southeast Mississippi Rural Health Initiative, Inc. | Clinic/Center | 44 Brooklyn Janice Rd, Brooklyn, MS 39425-9731 | 2006-03-03 |
1659844496 | Charles F Diamond | Nurse Practitioner | 44 Brooklyn Janice Rd, Brooklyn, MS 39425-9731 | 2019-01-04 |
1568867455 | Kaylora L Bingham | Nurse Practitioner | 44 Brooklyn Janice Rd, Brooklyn, MS 39425-9731 | 2014-11-04 |
1306881149 | Southeast Mississippi Rural Health Initiative, Inc | Clinic/Center | 8 Burborne St, Brooklyn, MS 39425-9732 | 2006-06-17 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1184225880 | Aleksandr Gurgov | Nurse Practitioner | 740 E 9th St, Brooklyn, NY 11230-2202 | 2020-11-08 |
1255932935 | Emily W Wang | Speech-Language Pathologist | 486 E 28th St Apt 702, Brooklyn, NY 11226-7994 | 2020-11-08 |
1396346136 | Amarachukwu U Egbujor | Nurse Practitioner | 565 Pine St, Brooklyn, NY 11208-3901 | 2020-11-06 |
1225639099 | Munisa Mukhamatkulova | Specialist | 1133 E 73rd St, Brooklyn, NY 11234-5409 | 2020-11-06 |
1740881663 | Lauren Amigo | Art Therapist | 86 Fleet Pl Apt 5t, Brooklyn, NY 11201-7132 | 2020-11-06 |
1326649146 | Cosmic Psych-medx | Marriage & Family Therapist | 2065 E 54th St Apt 2, Brooklyn, NY 11234-4750 | 2020-11-06 |
1437750585 | Eric Grant Shorey | Psychoanalyst | 91 Jewel St Apt 3r, Brooklyn, NY 11222-3025 | 2020-11-05 |
1700487774 | Rebecca Kason | Psychologist | 38 Broome St Apt 2b, Brooklyn, NY 11222-5515 | 2020-11-05 |
1477154540 | Rachel Steinhardt | Counselor | 2917 Avenue M Side Door, Brooklyn, NY 11210-4616 | 2020-11-05 |
1043811102 | Krisja Hendricks | Dance Therapist | 978 Metropolitan Ave Apt 2, Brooklyn, NY 11211-2635 | 2020-11-05 |
Find all providers in BROOKLYN |
Taxonomy Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
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1932682838 | Hudson River Healthcare, Inc. | Clinic/Center | 2400 Linden Boulevard, Brightpoint Health Part 822-4 Outpatient Services, Brooklyn, NY 11208-4830 | 2018-09-07 |
1568910545 | Oda Primary Health Care Network, Inc. | Clinic/Center | 329 Hewes St, Brooklyn, NY 11211-7474 | 2016-09-19 |
1104274745 | Premium Health, Inc. | Clinic/Center | 5506 15th Ave, Brooklyn, NY 11219-4301 | 2016-05-24 |
1477909349 | Damian Family Care Centers, Inc. | Clinic/Center | 599 Ralph Ave, Brooklyn, NY 11233 | 2016-05-10 |
1619366978 | Brooklyn Plaza Medical Center, Inc | Clinic/Center | 297 Myrtle Ave, Brooklyn, NY 11205-2901 | 2015-01-09 |
1730592403 | The Floating Hospital Inc. | Clinic/Center | 515 Blake Ave, Brooklyn, NY 11207-4502 | 2014-06-10 |
1275946550 | The Floating Hospital Inc. | Clinic/Center | 10875 Avenue D, Brooklyn, NY 11236-1931 | 2014-06-04 |
Find all providers in BROOKLYN |
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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.