Organization
PETAL SCHOOL CLINIC
Active
Organization
PETAL SCHOOL CLINIC
Active
Other names
Petal School Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE ROBINSON CEO (CHEIF EXECUTIVE OFFICER)
(601) 545-8700
Entity
Organization
Contact information
Practice address
36 PANTHER STADIUM DR, PETAL, MS 39465-3632
(601) 450-2144
(601) 450-2145
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-8700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002622599
—
MS
05
—
02622599
—
MS
01
—
251023
MS MEDICARE PTAN
MS
Enumeration date
01/31/2014
Last updated
02/06/2026
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