Picayune Family Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Picayune, MS
NPI 1003013764 · NPPES record last updated Feb 6, 2026
Key facts
- NPI
- 1003013764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- PICAYUNE FAMILY HEALTH CENTER
- Practice address
- 1911 Read Rd
Picayune, MS 39466-2730 - Phone
- (601) 545-8700
- Fax
- (601) 582-5461
- NPI assigned
- Jun 27, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC
Authorized official
- Name
- Janice Robinson
- Title
- C.E.O.
- Phone
- (601) 545-8700
Other NPIs on the same Medicare enrollment 19
Corporate family (same tax ID) 12
Facilities with the same owner 36
Practitioners 34
-
Michelle E Howard, LCSW
-
Leticia Dione Seydel, LPC
-
Veronica Tassin, DO
-
Johanna M Alvarez, MSN, FNP-BC
-
Trish Anne Brix-Baskin, LCSW
-
Brandon L Coleman, D. O.
-
Charles F Diamond, FNP-BC
-
Ronda Carol Eason-Hinton, FNP-BC
-
Melanie Lynn Frierson, FNP-C
-
Melissa Dawn Gaspar, APRN, CNM, FNP-C
-
Susan E Gentry, FNP
-
Jennifer Ross Goodwin, PNP-PC
-
Joshua Peter Hand, M.D.
-
Aspen Hardges, LCSW
-
Charlene Hicks, NP
-
Charlotte Denise Jordan, MSN, FNP-C
-
Keith A Kersten, D.O.
-
Kisha L Knight, FNP-BC
-
Tracy Leigh Ladner, C.F.N.P
-
Erin Lazenby, CPNP
-
Karen Lee, PMHNP-BC
-
Robin Murphree, CFNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D1075236 | Picayune Family Health Center | Provider-performed microscopy | Oct 15, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS
Federally qualified health center certification: CCN 251966
- Legal name
- SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
- Doing business as
- PICAYUNE FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 26, 2007
- Last certification
- Jul 26, 2007
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 29, 1979 in MS
- Enrollment address
- 1911 Read Rd
Picayune, MS 39466-2730
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Larry Davis |
Corporate Director |
Mar 23, 2021 | |
| Karen Speed |
Corporate Director | Jun 29, 2004 | |
| Nanni Freeman |
Corporate Director | Apr 26, 2005 | |
| Southeast Mississippi Rural Health Initiative, Inc. |
5% Or Greater Direct Ownership Interest | May 29, 1979 | 100% |
| Kermit Rayborn |
Corporate Director | Oct 22, 1996 | |
| Maxine Bolton |
Corporate Director |
Oct 28, 2014 | |
| Janice Robinson |
Corporate Officer |
Jan 23, 2023 | 100% |
| Corporate Director |
Jan 23, 2023 | 100% | |
| W-2 Managing Employee |
Jan 23, 2023 | 100% | |
| Billy Folkes |
Corporate Director | Sep 25, 2007 | |
| Virginia Burks |
Corporate Director | Jan 1, 1954 | |
| Joyce Woullard |
Corporate Director | Sep 26, 1995 | |
| Derrick Autmon |
Corporate Director |
Jun 23, 2015 |
All facility ownership & control disclosures 36
| Facility | Type | Role | Since |
|---|---|---|---|
| Hattiesburg Public School and Community Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Woodley Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Hattiesburg High School and Community Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| N. R. Burger School and Community Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Minor Care Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Lumberton Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Brooklyn Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| New Augusta Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Women'S Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Hattiesburg Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Seminary Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Petal Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Petal Primary School |
Federally qualified health center | Operational/Managerial Control (100%) | May 29, 1979 |
| Petal Upper Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Petal Middle School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Petal High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Hattiesburg High School Campus |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Petal School Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Semrhi Support Service Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Forrest County Agricultural High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1976 |
| Baxterville School (K -8) |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Purvis Lower Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Oak Grove Longleaf |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Purvis High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 14, 2022 |
| Sumrall Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Lamar County School Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Oak Grove Elementary |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Sumrall High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Sumrall Middle School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Purvis Middle School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Oak Grove High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Oak Grove Middle School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Lumberton Elementary |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Purvis Upper Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
| Lumberton High School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 1, 2022 |
| Bellevue Elementary |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 29, 1979 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040319000300 | MS | Part B Supplier - Clinic/Group Practice | 2466342605 |
Receives reassigned benefits from 59 practitioners 19 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brooklyn, MS; Sumrall, MS; Seminary, MS; Picayune, MS; Petal, MS; New Augusta, MS; Lumberton, MS; Hattiesburg, MS… |
| O20070717000745 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 2466342605 | Practice locations: Picayune, MS |
National Provider Directory
- Tax ID family
- Seminary Clinic
- Part of
- Seminary Clinic
Locations
1300 Beaumont Brooklyn Rd
Beaumont, MS 39423
Phone (601) 784-3393
8 Burborne St
Brooklyn, MS 39425
Phone (601) 545-7714
10 Archie Smith Rd
Hattiesburg, MS 39402
Phone (601) 268-2217
70 Leaf Ln
Hattiesburg, MS 39402
Phone (601) 264-9764
Networks
- AL HMO
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | MS | Yes |
Addresses
Primary practice location
1911 Read Rd
Picayune, MS 39466-2730
Mailing address
PO Box 1729
Hattiesburg, MS 39403-1729
Phone (601) 545-8700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007250059 | Medicaid | MS |
Other names
- Picayune Family Health Center
Other providers in Picayune, MS
- Picayune Clinic LLC
- Picayune Drug Co. North
- Picayune Drug Co., Inc.
- Picayune Drug Co., Inc.
- Picayune Eye Clinic
- Picayune Family Practice Clinic, LLC
- Picayune General Dentistry, Inc.
- Picayune Homecare, LLC
- Picayune Medical & Health Supplies Inc
- Picayune Medical & Health Supplies Inc
All providers in Picayune, MS · Federally Qualified Health Center (FQHC) in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.