NPIMap

Minor Care Clinic

Organization Active NPI Federally Qualified Health Center (FQHC) · Hattiesburg, MS

NPI 1508874769 · NPPES record last updated Feb 6, 2026

Key facts

NPI
1508874769
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
MINOR CARE CLINIC
Practice address
123 S 27TH Ave
Hattiesburg, MS 39401-7136
Phone
(601) 450-3030
Fax
(601) 450-3031
NPI assigned
Aug 4, 2006
Organization subpart
Yes
Parent organization (as reported)
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC

Authorized official

Name
Janice Robinson
Title
Ceo
Phone
(601) 545-8700

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 24

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

Facilities with the same owner 36

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

View all 36

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D1059468Minor Care Clinic
123 South 27TH Avenue, Hattiesburg, MS 39401		Provider-performed microscopyApr 4, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MS

Federally qualified health center certification: CCN 251961

Legal name
SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Doing business as
MINOR CARE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 5, 2006
Last certification
Oct 5, 2006
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
May 29, 1979 in MS
Enrollment address
123 S 27TH Ave
Hattiesburg, MS 39401-7136

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.

NameRoleSinceShare
Larry Davis
Individual 		Corporate Director
Board Member		 Mar 23, 2021
Deborah Gambrell
Individual 		Corporate Director
Board Member		 Jun 27, 2023
Karen Speed
Individual 		Corporate Director Jun 29, 2004
Sherlita Babineaux
Individual 		Corporate Director
Board Member		 Oct 31, 2023
Nanni Freeman
Individual 		Corporate Director Apr 26, 2005
Southeast Mississippi Rural Health Initiative, Inc.
Organization · Hattiesburg, MS
Corporation, Medical provider/supplier, Non-profit 		5% Or Greater Direct Ownership Interest May 29, 1979 100%
Maxine Bolton
Individual 		Corporate Director
Board Member - Secretary		 Oct 28, 2014
Janice Robinson
Individual 		Corporate Officer
Ceo		 Jan 23, 2023 100%
Corporate Director
Ceo		 Jan 23, 2023 100%
W-2 Managing Employee
Ceo		 Jan 23, 2023 100%
Virginia Burks
Individual 		Corporate Director Jan 1, 1995
Joyce Woullard
Individual 		Corporate Director Sep 26, 1995
Derrick Autmon
Individual 		Corporate Director
Vice President of Board Members		 Jun 23, 2015
Terry King
Individual 		Corporate Director
Board Member		 Jun 27, 2023

All facility ownership & control disclosures 36

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

FacilityTypeRoleSince
Hattiesburg Public School and Community Clinic
Hattiesburg, MS · CCN 251934		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Woodley Elementary School
Hattiesburg, MS · CCN 251942		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Hattiesburg High School and Community Clinic
Hattiesburg, MS · CCN 251943		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
N. R. Burger School and Community Clinic
Hattiesburg, MS · CCN 251941		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Picayune Family Health Center
Picayune, MS · CCN 251966		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Lumberton Family Health Center
Lumberton, MS · CCN 251865		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Brooklyn Family Health Center
Brooklyn, MS · CCN 251864		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
New Augusta Family Health Center
New Augusta, MS · CCN 251816		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Women'S Health Center
Hattiesburg, MS · CCN 251874		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Hattiesburg Family Health Center
Hattiesburg, MS · CCN 251849		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Seminary Family Health Center
Seminary, MS · CCN 251814		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Elementary School
Petal, MS · CCN 251013		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Primary School
Petal, MS · CCN 251017		 Federally qualified health center Operational/Managerial Control (100%) May 29, 1979
Petal Upper Elementary School
Petal, MS · CCN 251016		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Petal Middle School
Petal, MS · CCN 251012		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Petal High School
Petal, MS · CCN 251015		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Hattiesburg High School Campus
Hattiesburg, MS · CCN 251009		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Petal School Clinic
Petal, MS · CCN 251023		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Semrhi Support Service Center
Hattiesburg, MS · CCN 251070		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Forrest County Agricultural High School
Brooklyn, MS · CCN 251068		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1976
Baxterville School (K -8)
Lumberton, MS · CCN 251129		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Purvis Lower Elementary School
Purvis, MS · CCN 251132		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Oak Grove Longleaf
Hattiesburg, MS · CCN 251133		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis High School
Purvis, MS · CCN 251145		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 14, 2022
Sumrall Elementary School
Sumrall, MS · CCN 251136		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Lamar County School Clinic
Purvis, MS · CCN 251138		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove Elementary
Hattiesburg, MS · CCN 251146		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Sumrall High School
Sumrall, MS · CCN 251147		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Sumrall Middle School
Sumrall, MS · CCN 251139		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis Middle School
Purvis, MS · CCN 251142		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove High School
Hattiesburg, MS · CCN 251141		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Oak Grove Middle School
Hattiesburg, MS · CCN 251131		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Lumberton Elementary
Lumberton, MS · CCN 251130		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Purvis Upper Elementary School
Purvis, MS · CCN 251135		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979
Lumberton High School
Lumberton, MS · CCN 251144		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2022
Bellevue Elementary
Hattiesburg, MS · CCN 251152		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 29, 1979

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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…
O20060829000552 MS Part a Provider - Federally Qualified Health Center (FQHC) 2466342605 Practice locations: Hattiesburg, MS

National Provider Directory

Tax ID family
Seminary Clinic (59 organizations share this tax ID)
Part of
Seminary Clinic

Locations

2006 Oferral St
Hattiesburg, MS 39401
Phone (601) 583-8112

68 Old Airport Rd
Hattiesburg, MS 39401
Phone (601) 583-4800

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MS Yes

Addresses

Primary practice location

123 S 27TH Ave
Hattiesburg, MS 39401-7136

Mailing address

PO Box 1729
Hattiesburg, MS 39403-1729
Phone (601) 545-8700

Other identifiers

IdentifierTypeStateIssuer
004786024MedicaidMS

Other names

  • Minor Care Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 6, 2026.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770336000000",
    "number": "1508874769",
    "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": "601-545-8700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 S 27TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017136",
            "telephone_number": "601-450-3030",
            "fax_number": "601-450-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINOR CARE CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC",
        "enumeration_date": "2006-08-04",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "CEO",
        "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": "004786024",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minor Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Minor Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hattiesburg, MS

All providers in Hattiesburg, MS · Federally Qualified Health Center (FQHC) in Mississippi

Sources for this page

Verify at the official NPI Registry.