| Sumrall High School | |
|
184 Center Ave Sumrall MS 39482-9629 | |
| (601) 758-4730 | |
| (601) 796-9437 |
| Full Name | Sumrall High School |
|---|---|
| Speciality | Clinic/Center |
| Location | 184 Center Ave, Sumrall, Mississippi |
| Authorized Official Name and Position | Kaye Ray (CEO) |
| Authorized Official Contact | 6015458700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sumrall High School Po Box 1729 Hattiesburg MS 39403-1729 Ph: (601) 545-8700 | Sumrall High School 184 Center Ave Sumrall MS 39482-9629 Ph: (601) 758-4730 |
| NPI Number | 1194399360 |
|---|---|
| Provider Enumeration Date | 05/13/2021 |
| Last Update Date | 09/06/2022 |
| Medicare PECOS PAC ID | 2466342605 |
|---|---|
| Medicare Enrollment ID | O20220929001959 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194399360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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