Provider Demographics
NPI:1548359565
Name:OUTREACH HEALTH SERVICES,INC.
Entity type:Organization
Organization Name:OUTREACH HEALTH SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-687-5859
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:130 N HIGH ST
Mailing Address - City:SHUBUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39360-0527
Mailing Address - Country:US
Mailing Address - Phone:601-687-5859
Mailing Address - Fax:601-687-5408
Practice Address - Street 1:130 NORTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:SHUBUTA
Practice Address - State:MS
Practice Address - Zip Code:39360
Practice Address - Country:US
Practice Address - Phone:601-687-5859
Practice Address - Fax:601-687-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08384012Medicaid
MS09013496Medicaid
MS251831Medicare ID - Type Unspecified
MS251839Medicare ID - Type Unspecified
MS08384012Medicaid