PICAYUNE FAMILY HEALTH CENTER (SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.) NPI 1003013764

Clinic/Center (Federally Qualified Health Center (FQHC)) in Picayune, MS

NPI 1003013764 Organization Clinic/Center Federally Qualified Health Center (FQHC) CLIA Number 25D1075236 CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP)

About PICAYUNE FAMILY HEALTH CENTER (SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.)

Picayune Family Health Center (southeast Mississippi Rural Health Initiative, Inc.) is a primary care provider established in Picayune, Mississippi specializing in clinic/center (federally qualified health center (fqhc)) . The NPI number of Picayune Family Health Center (southeast Mississippi Rural Health Initiative, Inc.) is 1003013764 and was assigned on June 2007. The practitioner's primary taxonomy code is 261QF0400X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's is doing business as Picayune Family Health Center. The authorized official of this NPI record is Mrs. Geroldean Dyse (C.e.o.)

A primary care provider (PCP) like Picayune Family Health Center sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc

The CLIA number of Picayune Family Health Center is 25D1075236 registered as a "federally qualified health center" facility with a CLIA Certificate for Provider-Performed Microscopy Procedures (PPMP). This CLIA certificate is issued to Picayune Family Health Center in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.

NPI

1003013764

Provider NamePICAYUNE FAMILY HEALTH CENTER (SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.)
Provider Location Address1911 READ RD PICAYUNE, MS 39466
Provider Mailing AddressPO BOX 1729 HATTIESBURG, MS 39403
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Other Organization NamePICAYUNE FAMILY HEALTH CENTER
Other Name TypeDoing Business As (3)
Enumeration Date06-27-2007
Last Update Date04-15-2021


Primary Taxonomy

Taxonomy Code261QF0400X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationFederally Qualified Health Center (FQHC)
License StateMS

Business Address

PICAYUNE FAMILY HEALTH CENTER
1911 READ RD
PICAYUNE, MS
ZIP 39466
Phone: (601) 545-8700
Fax: (601) 582-5461

Get Directions


Mailing Address

PICAYUNE FAMILY HEALTH CENTER
PO BOX 1729
HATTIESBURG, MS
ZIP 39403
Phone: (601) 545-8700
Fax: (601) 582-5461



Authorized Official

Authorized Official NameMRS. GEROLDEAN DYSE
Authorized Official TitleC.E.O.
Authorized Official Phone(601) 545-8700

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003013764 is:

CLIA Number25D1075236
Facility TypeFEDERALLY QUALIFIED HEALTH CENTER
Certificate TypeCertificate for Provider-Performed Microscopy Procedures (PPMP)

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
07250059MEDICAID (05)MS
C02142OTHER (01)MS

Other Providers at the same location


The following 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1144384173 JOSE A CARLO MD
Individual
Internal Medicine1911 READ RD
PICAYUNE, MS 39466
(601) 450-3500
1912249343 KELVINNA MCLEMORE ALEXANDER NP-C
Individual
Nurse Practitioner (Family)1911 READ RD
PICAYUNE, MS 39466
(601) 251-3500
1770562647DR. GEORGE ARTHUR APPLEWHITE M.D.
Individual
Preventive Medicine (Public Health & General Preventive Medicine)1911 READ RD
PICAYUNE, MS 39466
(601) 251-3500
1407301237 STEPHANIE RACHELLE LUMPKIN-FREEMAN FNP-C
Individual
Nurse Practitioner (Family)1911 READ RD
PICAYUNE, MS 39466
(601) 251-3500

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.