Provider Demographics
NPI:1861515587
Name:SOUTHWEST HEALTH AGENCY FOR RURAL PEOPLE, INC.
Entity type:Organization
Organization Name:SOUTHWEST HEALTH AGENCY FOR RURAL PEOPLE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-876-4926
Mailing Address - Street 1:101 HOSPITAL DR
Mailing Address - Street 2:P.O. BOX 32
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2021
Mailing Address - Country:US
Mailing Address - Phone:601-876-4926
Mailing Address - Fax:601-876-4333
Practice Address - Street 1:101 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2021
Practice Address - Country:US
Practice Address - Phone:601-876-4926
Practice Address - Fax:601-876-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09010051Medicaid
MS09010051Medicaid