Provider Demographics
NPI:1619025269
Name:NORTHEAST MS HEALTH CARE, INC.
Entity Type:Organization
Organization Name:NORTHEAST MS HEALTH CARE, INC.
Other - Org Name:BYHALIA FAMILY HEALTH CENTER - DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-838-2163
Mailing Address - Street 1:12 EAST BRUNSWICK AVE.
Mailing Address - Street 2:P.O. BOX 698
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611
Mailing Address - Country:US
Mailing Address - Phone:662-838-2163
Mailing Address - Fax:662-838-7944
Practice Address - Street 1:12 EAST BRUNSWICK
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611
Practice Address - Country:US
Practice Address - Phone:662-838-2163
Practice Address - Fax:662-838-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9011641Medicaid