Organization
SOUTHERN HEALTH CORP. OF HOUSTON, INC.
Active
Other names
Trace Family Health & Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHEILA BROCKMAN (CEO)
(662) 456-3700
Entity
Organization
Contact information
Practice address
1002 E MADISON ST STE B, HOUSTON, MS 38851-2428
(662) 456-2800
(662) 456-1715
Mailing address
PO BOX 432, HOUSTON, MS 38851-0432
(662) 456-2800
(662) 456-1715
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07978511
—
MS
01
—
258518
TRISPAN
MS
01
—
C02335
MEDICARE PART B GROUP
MS
Enumeration date
08/27/2006
Last updated
01/18/2024
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