Mary Bethune Alternative School
Organization Active NPI Federally Qualified Health Center (FQHC) · Hattiesburg, MS
NPI 1790725224 · NPPES record last updated Feb 6, 2026
Key facts
- NPI
- 1790725224
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MARY BETHUNE ALTERNATIVE SCHOOL
- Practice address
- 610 Dumas Ave
Hattiesburg, MS 39401-6424 - Phone
- (601) 545-8700
- Fax
- (601) 582-5461
- NPI assigned
- Jun 6, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
Authorized official
- Name
- Janice Robinson
- Title
- Chief Executive Officer
- Phone
- (601) 545-8700
Corporate family (same tax ID) 24
Practitioners 1
-
Clyde Rozell Chapman II, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Federally qualified health center certification: CCN 251944
- Legal name
- SOUTHEAST MISSISSIPPI RURAL HEALTH INITIATIVE, INC.
- Doing business as
- MARY BETHUNE ALTERNATIVE SCHOOL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 29, 2005
- Last certification
- Mar 29, 2005
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 29, 1979 in MS
- Enrollment address
- 610 Dumas Avenue
Hattiesburg, MS 39401-6424
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Larry Davis |
Corporate Director |
Mar 23, 2021 | |
| Deborah Gambrell |
Corporate Director |
Jun 27, 2023 | |
| Karen Speed |
Corporate Director |
Jun 29, 2004 | |
| Sherlita Babineaux |
Corporate Director |
Oct 31, 2023 | |
| Nanni Freeman |
Corporate Director | Apr 26, 2005 | |
| 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% | |
| Virginia Burks |
Corporate Director | Jan 1, 1995 | |
| Joyce Woullard |
Corporate Director |
Sep 26, 1995 | |
| Derrick Autmon |
Corporate Director |
Jun 23, 2015 | |
| Terry King |
Corporate Director |
Jun 27, 2023 |
All facility ownership & control disclosures 37
| 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 |
| Picayune Family Health Center |
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 |
|---|---|---|---|---|
| O20050302000924 | MS | Part a Provider - Federally Qualified Health Center (FQHC) | 2466342605 | Practice locations: Hattiesburg, MS |
National Provider Directory
- Tax ID family
- Seminary Clinic
- Part of
- Seminary Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | MS | Yes |
Addresses
Primary practice location
610 Dumas Ave
Hattiesburg, MS 39401-6424
Mailing address
PO Box 1729
Hattiesburg, MS 39403-1729
Phone (601) 545-8700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000602001 | Medicaid | MS |
Other names
- Mary Bethune Alternative School
Other providers in Hattiesburg, MS
- Ryan James Martin
- Tandy L Martin
- Terri M Martin
- William Allen Martin
- Charles Gordon Marx
- Katharyn Mary
- Cori Marzoni
- Jennifer Reeder Mascagni
- James Maurice Mask
- Brian Ross Maskew
All providers in Hattiesburg, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.