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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