| |
200 Main Street Seminary MS 39479-0000 | |
(601) 545-8700 | |
(601) 450-2493 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 200 Main Street, Seminary, Mississippi |
Authorized Official Name and Position | Kaye Ray (CEO) |
Authorized Official Contact | 6015458700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1729 Hattiesburg MS 39403-1729 Ph: (601) 545-8700 | 200 Main Street Seminary MS 39479-0000 Ph: (601) 545-8700 |
NPI Number | 1962953430 |
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Provider Enumeration Date | 10/20/2016 |
Last Update Date | 09/06/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962953430 | NPI | - | NPPES |
251045 | Other | MS | MS MEDICARE PTAN |
08557599 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |