NPIMap

Organization Active NPI

Mantachie Rural Health Care, Inc. Dental

  • Federally Qualified Health Center (FQHC)
  • Mantachie, MS
National Provider Identifier
1063779130
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MANTACHIE RURAL HEALTH CARE, INC. DENTAL
Practice address
5500 Hwy 363
Mantachie, MS 38855-7197
Phone
(662) 282-4226
Fax
(662) 282-7946
NPI assigned
Apr 13, 2012
Last updated
Oct 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Authorized official

Name
Karen Burns
Title
Coo
Phone
(662) 282-4226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

5500 Hwy 363
Mantachie, MS 38855-7197

Mailing address

5681 Hwy 363
Mantachie, MS 38855-7197
Phone (662) 282-4226

National Provider Directory

National Provider Directory
Tax ID family
Mantachie Rural Health5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1334275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1063779130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5681 HWY 363",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388557197",
            "telephone_number": "662-282-4226",
            "fax_number": "662-282-7946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 HWY 363",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388557197",
            "telephone_number": "662-282-4226",
            "fax_number": "662-282-7946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANTACHIE RURAL HEALTH CARE, INC. DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-13",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "662-282-4226"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mantachie, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.