Petal High School

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

PETAL HIGH SCHOOL

Practice address

1145 Highway 42
Petal, MS 39465-9740

Phone

(601) 545-8700

Fax

(601) 450-2493

NPI assigned

Jan 11, 2013

Organization subpart

Yes

Parent organization

SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janice Robinson

Title

C E O

Phone

(601) 545-8700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Petal High School Other name

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Federally qualified health center certification: CCN 251015

Legal name

SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.

Doing business as

PETAL HIGH SCHOOL

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 1, 2013

Last certification

Jan 1, 2013

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

May 8, 1979 in MS

Enrollment address

1145 Highway 42
Petal, MS 39465-9740

Part of

Seminary Clinic

Networks

• AL HMO

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 36

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Facilities with the same owner 36

Facilities that share an organizational owner with 5% or greater ownership or operational control.

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The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770249600000",
    "number": "1003153073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-3700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 HIGHWAY 42",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394659740",
            "telephone_number": "601-545-8700",
            "fax_number": "601-450-2493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETAL HIGH SCHOOL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.",
        "enumeration_date": "2013-01-11",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "C E O",
        "authorized_official_telephone_number": "601-545-8700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007003741",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Petal High School",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Petal High School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Joseph J Patterson, DPT
• Petal Chiropractic Clinic, Inc.
• Petal Dental Properties
• Petal Drug Company, Inc.
• Petal Family Dentistry
• Petal Middle School
• Petal Primary School
• Petal School Clinic
• Petal School District
• Petal School District

• Federally Qualified Health Center (FQHC) in Petal, MS
• Providers in Petal, MS by specialty
• Federally Qualified Health Center (FQHC) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.