Organization
SOUTHERN HEALTH CORP. OF HOUSTON, INC
Active
Other names
Trace Regional Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
GARY L STATEN (C.E.O.)
(662) 456-1000
Entity
Organization
Contact information
Practice address
1002 E MADISON ST, HOUSTON, MS 38851-2417
(662) 456-3700
(662) 456-1159
Mailing address
P.O. BX 626, HOUSTON, MS 38851
(662) 456-3700
(662) 456-1159
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013117
—
MS
05
—
09013354
—
MS
Enumeration date
12/20/2007
Last updated
11/19/2018
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